title: Pilot Study on Early Postoperative Discharge in Pituitary Adenoma Patients: Effect of Socioeconomic Factors and Benefit of Specialized Pituitary Centers.
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.
authors.affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Sarkiss
authors.affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
authors.forename: James
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, Michigan, United States.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Papin
authors.affiliation: Department of Medicine-Endocrinology, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
authors.forename: Eliza B
authors.initials: EB
authors.lastname: Geer
authors.affiliation: Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
authors.forename: Rudrani
authors.initials: R
authors.lastname: Banik
authors.affiliation: Department of Neurology (Neuro-Ophthalmology), New York University School of Medicine, New York, New York, United States.
authors.forename: Janet C
authors.initials: JC
authors.lastname: Rucker
authors.affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
authors.forename: Barbara
authors.initials: B
authors.lastname: Oudheusden
authors.affiliation: Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
authors.forename: Satish
authors.initials: S
authors.lastname: Govindaraj
authors.affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
authors.forename: Raj K
authors.initials: RK
authors.lastname: Shrivastava
keywords: early discharge; endoscopic surgery; pituitary adenoma; skull base surgery; socioeconomics; specialized pituitary centers