Pilot Study on Early Postoperative Discharge in Pituitary Adenoma Patients: Effect of Socioeconomic Factors and Benefit of Specialized Pituitary Centers

• Published in: Journal of neurological surgery. Part B, Skull base Skull base, 2015-08, Vol.76 (4), p.323-330
• Main Authors: Sarkiss, Christopher A., Lee, James, Papin, Joseph A., Geer, Eliza B., Banik, Rudrani, Rucker, Janet C., Oudheusden, Barbara, Govindaraj, Satish, Shrivastava, Raj K.
• Format: Article
• Language: English
• Subjects: Original Article
• ISSN: 2193-6331; 2193-634X
• DOI: 10.1055/s-0035-1549004

Abstract Introduction  Pituitary neoplasms are benign entities that require distinct diagnostic and treatment considerations. Recent advances in endoscopic transsphenoidal surgery have resulted in shorter lengths of stay (LOS). We implemented a postoperative day (POD) 1 discharge paradigm involving a multidisciplinary approach and detailed preoperative evaluation and review of both medical and socioeconomic factors. Methods  The experience of a single neurosurgeon/ears, nose, throat (ENT) team was reviewed, generating a preliminary retrospective database of the first 30 patients who underwent resection of pituitary lesions under the POD 1 discharge paradigm. We assessed multiple axes from their preoperative, in-house, and postoperative care. Results  There were 14 men and 16 women with an average age of 53.8 years (range: 27–76 years). There were 22 nonsecretory and 8 secretory tumors with average size of 2.80 cm (range: 1.3–5.0 cm). All 30 patients underwent preoperative ENT evaluation. Average LOS was 1.5 ± 0.7 days. A total of 18 of 30 patients were discharged on POD 1. The insurance status included 15 with public insurance such as emergency Medicaid and 15 with private insurance. Four patients had transient diabetes insipidus (DI); none had permanent DI. Overall, 28 of 30 patients received postoperative steroids. Factors that contributed to LOS > 1 day included public insurance status, two or more medical comorbidities, diabetes mellitus, transient panhypopituitarism, and DI. Conclusion  The implementation of a POD 1 discharge plan for pituitary tumors is feasible and safe for elective patients. This implementation requires the establishment of a dedicated Pituitary Center model with experienced team members. The consistent limitation to early discharge was socioeconomic status. Efforts that incorporate the analysis of social disposition parameters with proper management of clinical sequelae are crucial to the maintenance of ideal LOS and optimal patient outcomes.