An Enhanced Recovery After Surgery Pathway for Pituitary Surgery: Pilot Assessment

Introduction: We developed a pituitary enhanced recovery after surgery (ERAS) pathway to decrease length of stay (LOS) and improve the patient experience after endonasal transsphenoidal pituitary surgery.

Objective: This article aims to assess safety and outcomes during our pituitary ERAS pathway pilot period (February to July 2024) compared with a historic series of consecutive cases prior to implementation of the pathway that would have met ERAS pathway criteria (June-December 2023).

Methods: This was a retrospective, single-institution case series of a novel pituitary ERAS pathway that included patients undergoing elective transnasal, transsphenoidal surgery for pituitary tumors. Patients undergoing expanded endonasal cases or those with long cases (>5 hours), an intraoperative transfusion, a high-flow cerebrospinal fluid (CSF) leak, or other perioperative complications were excluded.

Results: We enrolled 32 patients into the pituitary ERAS pathway following a multidisciplinary process for implementation. The average LOS was 1.4 days, and 63% of patients went home on postoperative day (POD) 1, while 12 patients were discharged on POD2 or POD3 due most frequently to transient DI (n = 3), gastrointestinal symptoms (n = 3), and attending preference (n = 2). As per our pathway, most patients received routine outpatient lab work on POD2 (85.7%) and follow-up within 5 to 7 days by an advanced practice provider (100%). Compared with 32 patients with equivalent age, sex, pathology, and case complexity (p > 0.05 for all) who underwent transsphenoidal surgery immediately prior to our ERAS pathway pilot, patients enrolled in our ERAS pathway had an average 0.9 day shorter length of stay (p < 0.001) and 4.3 fewer blood draws (p < 0.001). This ERAS pathway trended toward lower inpatient charges compared with the historic control ($9,549 or 9% lower, p = 0.07), and had similar rates of 30-day emergency room or urgent care visits (p = 0.23). There were no emergency room visits, urgent care visits, or readmissions due to dysnatremia or delayed CSF leak in either cohort, and there were no cases of postoperative stroke or death in either cohort.

Conclusion: This pilot study of our pituitary ERAS pathway confirms its safety and efficacy. Skull base programs should consider tailored clinical pathways to facilitate early discharge, improve the patient experience, and reduce costs after pituitary surgery.

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Artikel online veröffentlicht:
07. Februar 2025