Associations Between Tumor Characteristics, Postoperative Complications, and Early Versus Late Discharge After Endoscopic Endonasal Pituitary Adenoma Resection.

Abstract

Background and objectives: Enhanced recovery after surgery protocols have resulted in a paradigm change in perioperative care with applications in cranial neurosurgery. Protocols have been implemented to increase rates of early discharge with length of stay being an important metric after pituitary adenoma (PA) resection. The aim of this study was to assess characteristics associated with early discharge on postoperative day 1 or 2 (POD 1-2) after endoscopic endonasal surgery (EES) for PA.

Methods: An analysis was performed of 524 patients undergoing EES for PA resection from December 2012 to December 2022. Patients discharged POD 1 were compared with POD >2 patients to determine associations with tumor and patient characteristics, preoperative symptoms, and postoperative complications.

Results: Among 524 patients (mean age 51.7 years, 55.3% female), 267 (51.0%) were discharged POD 1-2. These patients were less likely to present with headaches (odds ratio [OR] = 0.61, 95% CI: 0.43-0.86, P = .007), vision loss (OR = 0.46, 95% CI: 0.32-0.65, P < .001), and cranial nerve palsy (OR = 0.42, 95% CI: 0.21-0.83, P = .02). Early discharge patients had smaller (22.7 vs 27.7 mm diameter, P < .001) and less invasive tumors (Knosp 3-4: OR = 0.66, 95% CI: 0.45-0.97, P = .04). Late discharge patients were more likely to have intraoperative cerebrospinal fluid leaks (OR = 2.40, 95% CI: 1.65-3.50, P < .001), transient diabetes insipidus (OR = 4.94, 95% CI: 2.23-10.88, P < .001), and more often received additional treatment such as hydrocortisone (OR = 3.23, 95% CI: 2.14-4.86, P < .001) or reoperation (OR = 11.18, 95% CI: 2.59-48.34, P < .001). In our multivariable analysis, smaller tumors were positively associated with early discharge (OR = 0.96, 95% CI: 0.94-0.98 per mm, P < .001), whereas transient diabetes insipidus was inversely associated (OR = 0.27, 95% CI: 0.10-0.53, P < .001). There was no significant association between readmission and early vs late discharge (8.3% vs 13.3%, P = .09).

Conclusion: Tumor characteristics and presenting symptoms may assist in determining patients who are appropriate for early discharge after EES for PA resection. POD 1-2 discharge seems to be a practical option for many patients after EES, without additional risk of readmission or further complications.