Abstract
Endoscopic endonasal transsphenoidal resection has been accepted as a routine therapy for pituitary adenoma, but the postoperative hospital stay is typically several days long. With the advantages of reduced cost and improved patient satisfaction, the application of ambulatory surgery (AS) has developed rapidly. However, AS was still rarely adopted in neurosurgery. Here we designed an AS treatment protocol for pituitary adenoma with the endoscopic endonasal approach (EEA), and reported our initial experiences regarding the safety and efficacy of the AS protocol. 63 patients who presented with pituitary adenoma were screened at the Department of Neurosurgery, Tangdu Hospital from July to September, 2017. A total of 20 pituitary adenoma patients who met the inclusion criteria underwent EEA surgery using this evidence-based AS protocol, which emphasized adequate assessment for eligibility, full preparation to minimize invasiveness, enhanced recovery, and active perioperative patient education. Of the 20 patients enrolled, 18 were discharged on the afternoon of the operation day with a median total length of stay (LOS) of 31 hours (range, 29–32) hours. The median LOS after surgery was 6.5 (range, 5–8) hours. Two patients were transferred from the AS protocol to conventional care due to intraoperative cerebrospinal fluid leakage (one case) and an unsatisfying post-anesthetic discharge score (one case). Complications included transient and reversible mild postoperative nausea and vomiting [visual analog scale (VAS) score <3], headache (VAS score <3) after the operation or early after discharge. No patient was readmitted. Our results supported the safety and efficacy of the AS protocol for pituitary adenoma patients undergoing EEA resection among eligible patients, and further evaluation of this protocol in controlled studies with a larger sample size is warranted.
Highlights
Www.nature.com/scientificreports hemorrhage, less post-operative pain, higher quality of life, and a shorter length of stay (LOS) with a lower incidence of postoperative complications[4]
As a large tertiary care hospital and one of the largest neurosurgery centers in China, we have implemented an evidence-based enhanced recovery after surgery protocol (ERAS) for elective craniotomy, which has been observed to lead to a shorter LOS and lower morbidity rates[6]
Though postoperative diabetes insipidus occurred in 16% of patients, patients were discharge on schedule and readmission was required in two patients for delayed presentation of a cerebrospinal fluid (CSF) leak
Summary
Www.nature.com/scientificreports hemorrhage, less post-operative pain, higher quality of life, and a shorter length of stay (LOS) with a lower incidence of postoperative complications[4]. These characteristics are consistent with the basic principles of AS5. As a large tertiary care hospital and one of the largest neurosurgery centers in China, we have implemented an evidence-based enhanced recovery after surgery protocol (ERAS) for elective craniotomy, which has been observed to lead to a shorter LOS and lower morbidity rates[6]. Building upon our neurosurgical ERAS protocol and experience, after reviewing the current literature on successful AS protocols in other surgical fields, we initiated an ambulatory protocol for pitutary adenomas resection via the EEA for selected patients. We reported and analyzed our initial experiences regarding the safety and efficacy of the AS protocol
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