Perioperative management of endoscopic transsphenoidal pituitary surgery

Hanson, Martin; Li, Hao; Geer, Eliza B.; Karimi, Sasan; Tabar, Viviane; Cohen, Marc A.

doi:10.1016/j.wjorl.2020.01.005

Cited by 17 publications

(13 citation statements)

References 99 publications

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“…A systematic review was performed to assess current evidence regarding best practice in the perioperative management of pituitary tumors 16 . This was made available to members of the multidisciplinary team and was carefully considered by stakeholders.…”

Section: Eras Development Processmentioning

confidence: 99%

“…A systematic review was performed to assess current evidence regarding best practice in the perioperative management of pituitary tumors. 16 This was made available to members of the multidisciplinary team and was carefully considered by stakeholders. In | 331 areas of clinical equipoise, such as the administration of perioperative prophylactic antibiotics, the clinical experience and preferences of the multidisciplinary team were taken into account.…”

Section: Establishment Of Best Practice Guidelinesmentioning

confidence: 99%

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Integration of an enhanced recovery after surgery program for patients undergoing pituitary surgery

Flukes

Laufer

Cracchiolo

et al. 2022

World j. otorhinolaryngol.-head neck surg.

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Evidence-based enhanced recovery after surgery (ERAS) programs aim to improve patient outcomes and shorten hospital stays. The objective of this study is to describe the development, implementation, and evolution of an ERAS protocol to optimize the perioperative management for patients undergoing endoscopic skull base surgery for pituitary tumors. A systematic review of the literature was performed, best practices were discussed with stakeholders, and institutional guidelines were established and implemented. Key performance indicators (KPI) were measured and patient-reported outcome surveys were collected. The ERAS protocol was introduced successfully at our institution.We describe the process of initiation of the program and the perioperative management of our patients. We demonstrated the feasibility of integration of ERAS protocols for pituitary tumors with multidisciplinary engagement, with a particular emphasis on the use of data informatics and metrics to monitor outcomes. We expect that this approach will translate to improved quality of care for these often-complex patients.

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Section: Eras Development Processmentioning

confidence: 99%

Section: Establishment Of Best Practice Guidelinesmentioning

confidence: 99%

Integration of an enhanced recovery after surgery program for patients undergoing pituitary surgery

Flukes

Laufer

Cracchiolo

et al. 2022

World j. otorhinolaryngol.-head neck surg.

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“…[98][99][100] We do not recommend the routine placement of preoperative or intraoperative lumbar drains in patients deemed to be at lower risk for CSF leak, consistent with previously described ERAS protocols for patients undergoing TSA. 10,11,14…”

Section: Lumbar Drain Utilizationmentioning

confidence: 99%

“…Single-center experiences evaluating the implementation of ERAS recommendations following skull base surgery have been published, with positive impacts on complication rate and readmission rates, as well as hospital length of stay. [10][11][12][13][14][15] However, protocols between centers have differed, and no evaluations of the strength of evidence for recommendations has been performed. In this study, we describe a comprehensive set of key interventions and systematically evaluate the best available evidence for the development of an ERAS protocol for patients undergoing transsphenoidal pituitary surgery.…”

mentioning

confidence: 99%

Optimizing Perioperative Care in Transsphenoidal Pituitary Surgery: Considerations for Enhanced Recovery After Surgery

Barrette

Douglas

Chorath

et al. 2022

Journal of Craniofacial Surgery

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Objective: To identify key recommendations for maximizing the efficiency and efficacy of perioperative care in transsphenoidal pituitary surgery. Methods: The authors performed a comprehensive literature search of Enhanced Recovery After Surgery protocols implemented for patients undergoing transsphenoidal adenomectomy (TSA); individual recommendations were abstracted, and the evidence base thoroughly reviewed. Results: The authors identified 19 individual recommendations pertinent to the care of patients undergoing TSA, which were subdivided into preoperative (n=6), intraoperative (n=6), and postoperative (n=7) interventions. Key factors recommended for minimizing length of stay, preventing readmission, and improving patient outcomes included comprehensive patient education, multidisciplinary evaluation, avoidance of routine lumbar drain placement and nasal packing, and rigorous postoperative monitoring of pituitary function and salt-water imbalances. The overall level of evidence for 7/19 (37%) implemented recommendations was found to be low, suggesting a need for continued research in this patient population. Conclusion: Several key interventions should be considered in the development of Enhanced Recovery After Surgery protocols for TSA, which may aid in further decreasing length of stay and promoting positive patient outcomes.

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“…This is essential in the preoperative planning of surgical procedures and patient counseling. [4][5][6] CRS is a common disease that occurs in approximately 5.5 to 28% of the population. [7][8][9][10][11] It affects quality of life and carries the risk of intracranial complications if left untreated.…”

Section: Introductionmentioning

confidence: 99%

Impact of Concurrent Chronic Rhinosinusitis on Complication Rates after Endonasal Endoscopic Skull Base Surgery: A Single-Center Experience

Albaharna

Alqurashi

Alshareef

et al. 2022

J Neurol Surg B Skull Base

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Objectives Preoperative planning of endoscopic skull base surgery (ESBS) is essential. The safety of performing surgery before managing sinus pathologies including concurrent chronic rhinosinusitis (CRS) in patients undergoing ESBS has been questioned. The current study aimed to evaluate and compare the complication rates between patients with and without CRS undergoing ESBS. Design This is a retrospective study. Setting Present study was conducted at tertiary referral center. Participants We included all patients who underwent ESBS between March 2015 and March 2021. However, patients who had surgical revision for remnant tumor, primary sinonasal tumor excision, and cerebrospinal fluid (CSF) leakage repair were excluded. The presence of concurrent CRS was determined according to the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020) criteria by reviewing electronic charts about the preoperative clinical assessment and CT scan images of the paranasal sinuses. Then, the incidence rates of postoperative meningitis, CSF leakage, and surgical site infection were compared between patients with and without concurrent CRS undergoing ESBS. Main Outcome Measures Postoperative complication rates in patients underwent ESBS with and without CRS. Results From a total of 130 ESBS cases, 99 patients were included in this study. Among them, 24 had concurrent CRS. One patient presented with postoperative meningitis, one with CSF leakage, and two with surgical site infections. The incidence rate of postoperative meningitis, CSF leakage, and surgical site infection did not significantly differ between patients with and without concurrent CRS. Conclusion Concurrent CRS is not a contraindication for ESBS. Moreover, simultaneous endoscopic sinus surgery can safely be performed without additional morbidity in ESBS.

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Perioperative management of endoscopic transsphenoidal pituitary surgery

Cited by 17 publications

References 99 publications

Integration of an enhanced recovery after surgery program for patients undergoing pituitary surgery

Integration of an enhanced recovery after surgery program for patients undergoing pituitary surgery

Optimizing Perioperative Care in Transsphenoidal Pituitary Surgery: Considerations for Enhanced Recovery After Surgery

Impact of Concurrent Chronic Rhinosinusitis on Complication Rates after Endonasal Endoscopic Skull Base Surgery: A Single-Center Experience

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