Enhanced Recovery Following Endoscopic Endonasal Pituitary Surgery: A Systematic Review and Meta-Analysis

Objective: To assess the currently available literature regarding enhanced recovery after surgery (ERAS) and similar protocols on length of stay and postoperative complications among patients undergoing endoscopic endonasal resection of pituitary adenomas.

Study Design: Embase, Web of Science, Medline, and Google Scholar databases were searched from their respective dates of inception until September 2022 for studies that assessed ERAS protocols among patients undergoing pituitary surgery. The primary outcome of interest was length of stay (LOS) following surgery. Secondary outcomes of interest included total complications, rate of readmission, and postoperative interventions/escalations of care (e.g., ICU, reoperation).

Results: Search results yielded 629 studies, from which four studies with a total of 285 patients were included in the final analysis. 166 patients went through an ERAS style protocol. The patients who went through an ERAS protocol had a postoperative LOS of 1.8 days, with 83% of these patients discharged on the first postoperative day. The ERAS cohort had a readmission rate of 4.2%, and nearly half of these readmissions were due to hyponatremia (1.8%). The control groups had a 4.2% and 1.7% overall readmission rate and hyponatremia readmission rate, respectively. There was a significant difference in LOS between the ERAS cohort, 1.8 days, and the control groups, 6.1 days (p < 0.05).

Conclusion: The available literature suggests that selected patients, who participate in ERAS style pathway, can be safely discharged on the first postoperative day following endoscopic endonasal pituitary surgery. Larger, appropriately powered studies would be necessary to understand who the right patients are for such a pathway and if there are greater complications with early postoperative discharge.

Level of Evidence: This study presents level 3 evidence as a systematic review of case series and trials without blinding and inconsistently applied reference standards.

Publikationsverlauf

Artikel online veröffentlicht:
01. Februar 2023