Abstract
Objective: The endoscopic transsphenoidal pituitary surgery has gained popularity and has shown excellent results with a more comfortable postoperative course. However, the quality of the early postoperative course is not well-established in endoscopic transsphenoidal pituitary surgery. We hypothesized that the quality of the early postoperative course would be improved when an enhanced recovery after surgery (ERAS) protocol and minimally invasive endoscopic transsphenoidal pituitary surgery is implemented.Methods: We implemented a perioperative management ERAS protocol for endoscopic transsphenoidal pituitary surgery by an experienced surgeon (Yuehui Ma) in our department from January 2018. From then the endoscopic transsphenoidal pituitary surgery was implemented with a minimally invasive technique, such as bony sella reconstruction and partial nasal packing. We compared the results of 78 endoscopic transsphenoidal pituitary surgery cases during the initiation of the ERAS protocol and minimally invasive technique implementation: 37 cases in the control group and 41 cases in the ERAS group. Outcomes assessed included the effectiveness and security of surgery, postoperative hospital length of stay (LOS), and postoperative status on postoperative day 1 (POD1).Results: Postoperative status on POD1, such as nasal ventilation, out of bed, headache score, and liquid supplement, had significant improvement (P < 0.05). The median postoperative LOS decreased from 8 days in the control group to 3 days in the ERAS group (P < 0.05). The ERAS group had better economic benefit with fewer hospital charges (P < 0.05). There was no difference in the early postoperative diabetes insipidus and 30-day readmission for epistaxis, hyponatremia, or other complications between the two groups.Conclusion: The quality of the early postoperative course was improved when a neurosurgical ERAS protocol and minimally invasive endoscopic transsphenoidal pituitary surgery with partially nasal packing were implemented. Endoscopic transsphenoidal pituitary day surgery could be recommended in some classes of patients though further evaluation in large case studies is warranted.
Highlights
Pituitary adenomas (PAs) are the most common benign neoplasms in the sellar region, and surgery by the transsphenoidal approach remains the best choice for a majority of PAs [1, 2]
There were no significant differences between the two groups in terms of the operative time, intraoperative cerebrospinal fluid (CSF) leak, and lumbar drain placed after operation
We believe our results suggest that improvement of the quality of the early postoperative course after endoscopic transsphenoidal pituitary surgery is an achievable goal by improving the surgical technique and perioperative management strategy
Summary
Pituitary adenomas (PAs) are the most common benign neoplasms in the sellar region, and surgery by the transsphenoidal approach remains the best choice for a majority of PAs [1, 2]. Multiple studies have shown shorter postoperative hospital length of stay (LOS) for patients undergoing endoscopic transsphenoidal pituitary surgery [6]. These studies focused on the results of surgical procedures, and only a few clinical researches report the quality of the early postoperative course after endoscopic transsphenoidal pituitary surgery [7, 8]. Invasive endoscopic pituitary surgery and a perioperative management protocol for the care of patients are the two important points to facilitate a short LOS, safe early discharge, and a more comfortable postoperative course [10]
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