Endoscopic Endonasal Transsphenoidal Surgery for the Resection of Pituitary Adenomas: A Prime Candidate for a Shortened Length of Stay Enhanced Recovery after Surgery Protocol? A Systematic Review

Harshal Shah; Avi Slavin; Julia Botvinov; Geoffrey R O'Malley Jr; Syed Sarwar; Nitesh V Patel

doi:10.1016/j.wneu.2024.03.135

Endoscopic Endonasal Transsphenoidal Surgery for the Resection of Pituitary Adenomas: A Prime Candidate for a Shortened Length of Stay Enhanced Recovery after Surgery Protocol? A Systematic Review

World Neurosurg. 2024 Mar 27:186:145-154. doi: 10.1016/j.wneu.2024.03.135. Online ahead of print.

Authors

Harshal Shah¹, Avi Slavin², Julia Botvinov², Geoffrey R O'Malley Jr², Syed Sarwar³, Nitesh V Patel⁴

Affiliations

¹ Department of Neurosurgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA. Electronic address: harshal.shah@hmnh.org.
² Department of Neurosurgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.
³ Department of Neurosurgery, HMH-Jersey Shore University Medical Center, Neptune, New Jersey, USA.
⁴ Department of Neurosurgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA; Department of Neurosurgery, HMH-Jersey Shore University Medical Center, Neptune, New Jersey, USA.

PMID: 38552787
DOI: 10.1016/j.wneu.2024.03.135

Abstract

Background: Enhanced Recovery After Surgery (ERAS) is a perioperative model of care aimed at optimizing postoperative rehabilitation and reducing hospital length of stay (LOS). Decreasing LOS avoids hospital-acquired complications, reduces cost of care, and improves patient satisfaction. Given the lack of ERAS protocols for endoscopic endonasal transsphenoidal surgery (EETS) resection of pituitary adenomas, a systematic review of EETS was performed to compile patient outcomes and analyze factors that may lead to increased LOS, reoperation, and readmission rates with the intention to contribute to the development of a successful ERAS protocol for EETS.

Methods: The authors performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines-based systematic review of the literature. Information was extracted regarding patient LOS, surgery complications, and readmission/reoperation rates. Pearson's correlations to LOS and reoperation/readmission rates were performed with variables normalized to the number of participants. Statistical significance was set at P value <0.05.

Results: Fourteen studies were included, consisting of 2083 patients. The most common complications were cerebrospinal fluid leaks (37%) and postoperative diabetes insipidus (DI) (9%). Transient DI was significantly correlated with shorter LOS. Functional pituitary adenomas were significantly correlated with lower readmission rates while nonfunctional pituitary adenomas were correlated with higher readmission rates. No other factor was found to be significantly correlated with a change in LOS or reoperation rate.

Conclusions: EETS may be an ideal candidate for the development of ERAS cranial protocols. While our data largely supports the safe implementation of shortened LOS protocols in EETS, our findings highlight the importance of transient DI and nonfunctional pituitary adenomas management when formulating ERAS protocols.

Keywords: Endoscopic endonasal transsphenoidal surgery; Enhanced recovery after surgery; Length of stay; Pituitary neoplasms.

Publication types

Review