Enhanced recovery and accelerated discharge after endoscopic transsphenoidal pituitary surgery: safety, patient feedback, and cost implications

Hughes, Mark; Culpin, Elizabeth; Darley, Roisin; McKinlay, Justin; Nix, Paola; Smedley, Alexander; Tyagi, Atul; Sheikh, Asim; Phillips, Nick

doi:10.1007/s00701-020-04282-0

Cited by 32 publications

(23 citation statements)

References 24 publications

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“…Further improvements in outcomes, complications, length of stay and readmission may be possible with implementation of enhanced recovery after surgery (ERAS) protocols including reduced narcotic use [60][61][62]. A continued focus in neurosurgery, otolaryngology and endocrinology residency and fellowship training programs, emphasizing comprehensive patient management may also help achieve more consistent and broader national improvements in pituitary surgery outcomes [12,45].…”

Section: Further Optimizing Outcomes In Pituitary Surgery With Protocol-driven Carementioning

confidence: 99%

Complication avoidance protocols in endoscopic pituitary adenoma surgery: a retrospective cohort study in 514 patients

et al. 2021

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Purpose To evaluate the impact of using consistent complication-avoidance protocols in patients undergoing endoscopic pituitary adenoma surgery including techniques for avoiding anosmia, epistaxis, carotid artery injury, hypopituitarism, cerebrospinal fluid leaks and meningitis. Methods All patients undergoing endoscopic adenoma resection from 2010 to 2020 were included. Primary outcomes included 90-day complication rates, gland function outcomes, reoperations, readmissions and length of stay. Secondary outcomes were extent of resection, short-term endocrine remission, vision recovery. Results Of 514 patients, (mean age 51 ± 16 years; 78% macroadenomas, 19% prior surgery) major complications occurred in 18(3.5%) patients, most commonly CSF leak (9, 1.7%) and meningitis (4, 0.8%). In 14 of 18 patients, complications were deemed preventable. Four (0.8%) had complications with permanent sequelae (3 before 2016): one unexplained mortality, one stroke, one oculomotor nerve palsy, one oculoparesis. There were no internal carotid artery injuries, permanent visual worsening or permanent anosmia. New hypopituitarism occurred in 23/485(4.7%). Partial or complete hypopituitarism resolution occurred in 102/193(52.8%) patients. Median LOS was 2 days; 98.3% of patients were discharged home. Comparing 18 patients with major complications versus 496 without, median LOS was 7 versus 2 days, respectively p < 0.001. Readmissions occurred in 6%(31/535), mostly for hyponatremia (18/31). Gross total resection was achieved in 214/312(69%) endocrine-inactive adenomas; biochemical remission was achieved in 148/209(71%) endocrine-active adenomas. Visual field or acuity defects improved in 126/138(91.3%) patients. Conclusion This study suggests that conformance to established protocols for endoscopic pituitary surgery may minimize complications, re-admissions and LOS while enhancing the likelihood of preserving gland function, although there remains opportunity for further improvements.

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Section: Further Optimizing Outcomes In Pituitary Surgery With Protocol-driven Carementioning

confidence: 99%

Complication avoidance protocols in endoscopic pituitary adenoma surgery: a retrospective cohort study in 514 patients

et al. 2021

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“…Elayat et al found that ERAS could reduce the proportion of patients requiring intensive care unit (ICU) stay > 48 hours after supratentorial neurosurgery ( 6 ). Hughes et al demonstrated that an ERAS protocol after elective endoscopic pituitary surgery could reduce length of stay and was associated with high patient satisfaction ( 7 ). However, the consensus has not been reached for evidence-based recommendations of it ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Application of and Clinical Research on Enhanced Recovery After Surgery in Perioperative Care of Patients With Supratentorial Tumors

Zhang

Chen

et al. 2021

Front. Oncol.

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PurposeThis study intends to explore the safety and effectiveness of the concept of enhanced recovery after surgery (ERAS) in the perioperative care of patients with supratentorial tumors.MethodsA total of 151 supratentorial tumor patients were enrolled in this study, and they were divided into control group (n = 75) and observation group (n = 76) according to the random number table method. Patients in the control group received routine neurosurgery care, and patients in the observation group received enhanced recovery after surgery care. The incidence of perioperative complications, postoperative hospital stays, early postoperative eating time, catheter removal time, and time to get out of bed were observed for the two groups of patients, and the quality of postoperative recovery was evaluated.ResultsThere was no statistically significant difference in the basic data of the two groups of patients, such as age, gender, lesion location, and condition (P>0.05), and they were comparable. The observation group’s postoperative eating time, catheter removal time, and time to get out of bed were significantly earlier than those of the control group. Postoperative hospital stays and hospitalization expenses were less than those of the control group. There was a statistically significant difference in postoperative hospital stay between the two groups (P<0.05).ConclusionApplying the ERAS concept to implement perioperative care for patients with supratentorial tumors is safe and effective. It can not only reduce after-surgical stress and accelerate postoperative recovery, but also shorten hospital stays and reduce hospital costs. It is worthy of clinical application.

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“…There is a growing interest in enhanced recovery after surgery (ERAS), and ERAS protocols are increasingly being investigated in the context of different surgical specialties including neurosurgery [43]. In a recent study aimed at developing and assessing the ERAS protocol for endoscopic transsphenoidal pituitary surgery, TIVA was included in the protocol as the main anesthetic technique [11]. However, this choice was based on a previously published report concluding that the risk for postoperative nausea and vomiting and time in the PACU were lower with propofol than with inhalational agents in ambulatory and inpatient surgery [36].…”

Section: Discussionmentioning

confidence: 99%

“…Adequate emergence also lowers the risk of surgical complications such as cerebrospinal fluid rhinorrhea due to coughing and enables a prompt neurological examination [7][8][9][10]. Moreover, there is an increasing demand for enhanced postoperative recovery after endoscopic pituitary surgery that is not limited to the immediate postoperative period [11]. Therefore, high quality recovery after endoscopic transsphenoidal surgery remains a challenge for neuroanesthesiologists.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effects of inhalational and total intravenous anesthesia on quality of recovery in patients undergoing endoscopic transsphenoidal pituitary surgery: a randomized controlled trial

et al. 2022

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Background: Endoscopic transsphenoidal pituitary surgery has shown promising results. However, fast and high-quality recovery after this procedure remains a challenge for neuroanesthesiologists. This study aimed to compare the quality of recovery after transsphenoidal pituitary surgery between patients who received inhalational anesthesia with sevoflurane and patients who received propofol-based total intravenous anesthesia (TIVA). Methods: Eighty-two patients undergoing transsphenoidal pituitary surgery were randomized to receive either sevoflurane inhalation with manual infusion of remifentanil (sevoflurane group) or effect-site target-controlled infusion of propofol and remifentanil (TIVA group). The primary outcome was the 40-item Quality of Recovery (QoR-40) score on postoperative day 1. The QoR-40 questionnaire was completed by patients the day before surgery and on postoperative days 1 and 2. Emergence agitation and recovery characteristics were also assessed. Results: There were no significant differences between the groups in the global QoR-40 scores on both postoperative days 1 and 2 (difference -8.7, 95% CI -18.0 to 0.7, and P = 0.204; -3.6, 95% CI -13.0 to 5.8, and P > 0.999, respectively). The time to verbal response and time to extubation were significantly shorter in the sevoflurane group than in the TIVA group (P < 0.001 and P < 0.001, respectively). However, the incidence of emergence agitation was lower in the TIVA group than in the sevoflurane group (P < 0.001). Conclusions: Both inhalational anesthesia with sevoflurane and propofol-based TIVA were appropriate anesthetic techniques for patients undergoing endoscopic transsphenoidal pituitary surgery in terms of the quality of recovery up to 2 days postoperatively. Rapid emergence was observed in the sevoflurane group, while smooth emergence was observed in the TIVA group.

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Enhanced recovery and accelerated discharge after endoscopic transsphenoidal pituitary surgery: safety, patient feedback, and cost implications

Cited by 32 publications

References 24 publications

Complication avoidance protocols in endoscopic pituitary adenoma surgery: a retrospective cohort study in 514 patients

Complication avoidance protocols in endoscopic pituitary adenoma surgery: a retrospective cohort study in 514 patients

Application of and Clinical Research on Enhanced Recovery After Surgery in Perioperative Care of Patients With Supratentorial Tumors

Comparison of the effects of inhalational and total intravenous anesthesia on quality of recovery in patients undergoing endoscopic transsphenoidal pituitary surgery: a randomized controlled trial

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