title: OUTCOME OF IMPLEMENTATION OF A MULTIDISCIPLINARY TEAM APPROACH TO THE CARE OF PATIENTS AFTER TRANSSPHENOIDAL SURGERY.
abstract: OBJECTIVE
  Transsphenoidal surgery (TS) for sellar lesions is an established and safe procedure, but complications can occur, particularly involving the neuroendocrine system. We hypothesized that postoperative care of TS patients would be optimized when performed by a coordinated team including a pituitary neurosurgeon, endocrinologists, and a specialty nurse.
  
  
  METHODS
  We implemented a formalized, multidisciplinary team approach and standardized postoperative protocols for the care of adult patients undergoing TS by a single surgeon (J.N.B.) at our institution beginning in July 2009. We retrospectively compared the outcomes of 214 consecutive TS-treated cases: 113 cases prior to and 101 following the initiation of the team approach and protocol implementation. Outcomes assessed included the incidence of neurosurgical and endocrine complications, length of stay (LOS), and rates of hospital readmission and unscheduled clinical visits.
  
  
  RESULTS
  The median LOS decreased from 3 days preteam to 2 days postteam (P<.01). Discharge occurred on postoperative day 2 in 46% of the preteam group patients compared to 69% of the postteam group (P<.01). Rates of early postoperative diabetes insipidus (DI) and readmissions within 30 days for syndrome of inappropriate antidiuretic hormone (SIADH) or other complications did not differ between groups.
  
  
  CONCLUSIONS
  Implementation of a multidisciplinary team approach was associated with a reduction of LOS. Despite earlier discharge, postoperative outcomes were not compromised. The endocrinologist is central to the success of this team approach, which could be successfully applied to care of patients undergoing TS, as well as other types of endocrine surgery at other centers.
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Carminucci
authors.forename: John C
authors.initials: JC
authors.lastname: Ausiello
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Page-Wilson
authors.forename: Michelle
authors.initials: M
authors.lastname: Lee
authors.forename: Laura
authors.initials: L
authors.lastname: Good
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Bruce
authors.forename: Pamela U
authors.initials: PU
authors.lastname: Freda
mesh_terms: D000236:Adenoma / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006284:Health Plan Implementation / Q000458:organization & administration / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000534:rehabilitation / Q000592:standards; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D010911:Pituitary Neoplasms / Q000453:epidemiology / Q000601:surgery*; D011182:Postoperative Care / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D013100:Sphenoid Bone / Q000601:surgery*; D016896:Treatment Outcome