Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Messerer, Mahmoud; Cossu, Giulia; George, Mercy; Daniel, Roy Thomas

doi:10.3791/55896

Cited by 11 publications

(17 citation statements)

References 32 publications

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“…A staged nursing intervention was used in this trial and has the benefit of allowing matching symptomatic nursing measures for patients' psyche and physiology in various clinical phases. Patients are more prone to suffer fear and anxiety before surgery due to their hazy comprehension of sickness and operation [25], psychological support is therefore necessary at this time. Early on, the nursing staff should pay more attention to the nutritional supplement of the patient's body.…”

Section: Discussionmentioning

confidence: 99%

Effects of Staged Nursing Care on Neuroendoscopic Transsphenoidal Pituitary Adenoma Resection and Postoperative Complications

Fei

Zhang

2022

Evidence-Based Complementary and Alternative Medicine

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Objective. The purpose of this study was to determine whether staged nursing had an impact on the outcome of neuroendoscopic transsphenoidal pituitary tumor resection and postoperative complications. Methods. As research participants, we chose 88 individuals with pituitary adenomas who were treated at our institution between February 2020 and November 2021; all patients received endoscopic transsphenoidal pituitary adenoma excision. The patients were randomly divided into two groups: the routine group (n = 44) and the stage group (n = 44). Patients in the routine group received care according to the routine nursing mode, and patients in the stage group received care according to the stage nursing mode. The staged nursing interventions included preoperative, intraoperative, and postoperative nursing. Postoperative recovery-related indicators such as the self-rating anxiety scale (SAS) and a self-rating depression scale (SDS), contentment, comfort, and postoperative complications were compared between the two groups. Results. The postoperative recovery-related indexes of patients in the stage group were significantly lower than those in the routine group ( P < 0.05 ); the SAS and SDS scores in the stage group after treatment were significantly lower than those in the routine group ( P < 0.05 ); patients in the stage group were significantly more satisfied with their treatment after treatment than those in the routine group ( P < 0.05 ); patients in the stage group were significantly more comfortable after treatment than those in the routine group ( P < 0.05 ); a significantly lower incidence of postoperative complications was observed in the stage group compared to the routine group ( P < 0.05 ). Conclusion. Patients with neuroendoscopic transsphenoidal pituitary tumor excision benefit greatly from staged nursing. The nursing approach may successfully assure the procedure’s smooth completion, boost patients’ postoperative recovery, and reduce patients’ worry, despair, and other unpleasant feelings. The nursing approach may successfully increase clinical satisfaction and comfort of patients by minimizing the likelihood of postoperative problems, and it is well-suited for practical use.

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Section: Discussionmentioning

confidence: 99%

Effects of Staged Nursing Care on Neuroendoscopic Transsphenoidal Pituitary Adenoma Resection and Postoperative Complications

Fei

Zhang

2022

Evidence-Based Complementary and Alternative Medicine

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Section: Introductionmentioning

confidence: 99%

“…Endoscopic transsphenoidal pituitary surgery (ETPS) has become a very common procedure to address pathology involving the pituitary gland. [1][2][3][4][5] While morbidity and mortality following ETPS are low, postoperative complications are unique due to both surgical complications and metabolic derangements. 3,6,7 Perioperative management incorporating a multidisciplinary team of otolaryngologist, neurosurgeons, and endocrinologist is essential in providing highquality patient care.…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary Postoperative Care Pathway to Reduce Readmissions following Endoscopic Transsphenoidal Pituitary Surgery: Improving Quality of Patient Care

Ghiam

Ali

Dable

et al. 2022

J Neurol Surg B Skull Base

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Background: Thirty-day unplanned readmission following endoscopic transsphenoidal pituitary surgery (ETPS) occurs in up to 14% of patients. Delayed hyponatremia is one of the most common causes, accounting for 30% of readmissions and often occurs within 1 week of surgery. The authors prior retrospective review identified endocrinology follow up as protective factor. Objectives: Implementation of a multidisciplinary post-operative care pathway (POC pathway): (a) to reduce 30-day hospital readmissions following ETSP; (b) improve inpatient and outpatient coordination of care with endocrinologist. Methods: Single institution temporal cohort study of patients prior to (control cohort) and after implementation of the POC pathway (intervention cohort). The POC pathway utilized post-discharge 1-1.5L/day fluid restriction, a post-operative day 5-7 serum sodium, and endocrinology follow up within 1 week of discharge to stratify patients into tiered hyponatremia regimens. Results: 542 patients were included in the study, 409 (75%) in the control cohort and 133 (25%) in the intervention cohort. All cause readmission was significantly reduced following implementation of the POC pathway (14% vs 6%, p=0.015). Coordination with endocrinologist significantly increased in the inpatient (96% vs. 83%, p <0.001)) and outpatient (77% vs. 68%, p=0.042) setting. Patients who were not in the POC pathway had the highest risk of readmission (OR: 2.5; 95% CI: 1.1-5.5). Conclusions: A multidisciplinary POC pathway incorporating endocrinologist in conjunction with post-discharge weight-based fluid restriction and post-operative serum sodium levels can safely be used to reduce 30-day readmissions following ETPS.

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“…2,3 Lesions of the pituitary gland are the most common indication for ETS. [3][4][5][6][7][8] Complications following endoscopic transsphenoidal pituitary surgery (ETPS) are unique due to risk related to both surgical complications and metabolic derangements. 5,9,10 Thus, perioperative management of patients undergoing surgery for pituitary tumors requires a multidisciplinary team of otolaryngologist, neurosurgeons, and endocrinologist.…”

Section: Introductionmentioning

confidence: 99%

30-Day Readmissions and Coordination of Care Following Endoscopic Transsphenoidal Pituitary Surgery: Experience with 409 Patients

Ghiam

Chyou

Dable

et al. 2021

J Neurol Surg B Skull Base

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Objective The study aimed to (1) quantify readmission rates and common causes of readmission following endoscopic transsphenoidal pituitary surgery (ETPS); (2) identify risk factors that may predict readmission within 30 days; (3) assess postoperative care coordination with endocrinology follow-up; and (4) identify patients for whom targeted interventions may reduce 30-day readmissions. Methods Retrospective quality improvement review of patients with pituitary adenoma who underwent ETPS from December 2010 to 2018 at a single tertiary care center. Results A total of 409 patients were included in the study, of which 57 (13.9%) were readmitted within 30 days. Hyponatremia was the most common cause of readmission (4.2%) followed by pain/headache (3.9%), cerebrospinal fluid leak (3.4%), epistaxis (2.7%), hypernatremia (1.2%), and adrenal insufficiency (1.2%). Patients with hyponatremia were readmitted significantly earlier than other causes (4.3 ± 2.2 vs. 10.6 ± 10.9 days from discharge, p = 0.032). Readmitted patients had significantly less frequent outpatient follow-up with an endocrinologist than the nonreadmitted cohort (56.1 vs. 70.5%, p = 0.031). Patients who had outpatient follow-up with an endocrinologist were at lower risk of readmission compared with those without (odds ratio: 0.46; 95% confidence interval: 0.24–0.88). Conclusion Delayed hyponatremia is one of the most common causes of 30-day readmission following ETPS. Postoperative follow-up with an endocrinologist may reduce risk of 30-day readmission following ETPS. Implications for Clinical Practice A multidisciplinary team incorporating otolaryngologist, neurosurgeons, and endocrinologist may identify patients at risk of 30-day readmissions. Protocols checking serum sodium within 1 week of surgery in conjunction with endocrinologist to tailor fluid restriction may reduce readmissions from delayed hyponatremia.

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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Cited by 11 publications

References 32 publications

Effects of Staged Nursing Care on Neuroendoscopic Transsphenoidal Pituitary Adenoma Resection and Postoperative Complications

Effects of Staged Nursing Care on Neuroendoscopic Transsphenoidal Pituitary Adenoma Resection and Postoperative Complications

Multidisciplinary Postoperative Care Pathway to Reduce Readmissions following Endoscopic Transsphenoidal Pituitary Surgery: Improving Quality of Patient Care

30-Day Readmissions and Coordination of Care Following Endoscopic Transsphenoidal Pituitary Surgery: Experience with 409 Patients

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