Evaluation of Early Postoperative Day 1 Discharge after Endoscopic, Endonasal Pituitary Adenoma Resection

Background: While multiple studies have evaluated the length of stay after endoscopic transsphenoidal surgery (ETS) for pituitary adenoma, the potential for early postoperative day 1 (POD1) discharge remains unclear. We compared POD1 and POD >1-day patients to better characterize factors that facilitate rapid discharge after ETS surgery.

Methods: A retrospective chart review was performed for patients undergoing ETS for pituitary adenoma at a single tertiary care academic center from 2005 to 2020. POD1 was defined as patients discharged within 24 hours of surgery.

Results: A total of 726 patients (mean age: 55 years, 52% male) were identified. On univariate analysis, POD 1 discharge significantly increased from each time interval: 2005–2010, 2011–2015, 2016–2020 (p = 0.0001). POD1 patients were more likely to have incidental pituitary adenomas (p = 0.001), use dural substitutes and Duraseal (p = 0.0001), have less intraoperative CSF leak (p = 0.015), and show lower postoperative complications (p = 0.005). POD 1 discharges also showed higher rates of macroadenomas (96.2 vs. 91.4%, p = 0.047), and lower rates of functional tumors (p = 0.024). POD > 1 group were more likely to have a 30-day readmission (p = 0.002), readmission after 30 days (p = 0.0001), past medical history of COPD (p = 0.046), nasal synechiae (p = 0.003), repeat MRI within 90 days (p = 0.0001), higher complications of diabetes insipidus (9.8 vs. 1.7% p = 0.0001) postoperative hypocortisolism (22.1 vs. 13.6% p = 0.022), and postoperative steroid usage (59.9 vs. 44.6% p = 0.003). On multivariant analysis, pituitary incidentaloma (OR, 0.613; 95% CI: 0.381–0.986, p = 0.044) and year of operation (OR, 0.459; 95% CI: 0.295–0.713; p = 0.001) favor POD 1 discharge. Diabetes insipidus (OR, 7.020; 95% CI: 2.006–24.572; p = 0.004) and intraoperative leak (OR, 2.002; 95% CI: 1.247–3.279; p = 0.004) are associated with increased risk for POD >1 discharge.

Conclusion: This study demonstrated that post-operative day one discharge after ETS for pituitary adenomas is safe, feasible and without increased risk of 30-day readmission in selected patients. On multivariant analysis, factors that are associated with increased risk of length of stay include diabetes insipidus and intraoperative leak. Implementation of these findings may allow for safe, early discharge of ETS patients.

Publikationsverlauf

Artikel online veröffentlicht:
12. Februar 2021