Effect of an Enhanced Recovery Protocol on Length of Stay and Readmission Rate following Endoscopic Endonasal Resection of Pituitary Adenomas at a Large Tertiary-Care Center

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Introduction: Reducing length of stay (LOS) and readmission improve healthcare value and outcomes. Standardized perioperative protocols may facilitate earlier discharge without compromising safety. Large data analyses investigating the utility of these protocols following surgery using an endoscopic endonasal approach (EEA) for pituitary adenomas are lacking. Materials and Methods: This single institution, retrospective study was conducted with data obtained from the electronic medical record (EMR) at NYU Langone Health. A total of 594 patients who underwent an EEA for resection of primary or recurrent pituitary adenoma at NYU Langone Health between 2012 and 2024 were included. Patients were categorized into 3 separate cohorts. Cohort 1 ( n = 167) was defined as patients treated between 2012 and 2018 with no formal post-operative management hospital policy. Cohort 2 ( n = 225) was defined as patients treated between 2018 and 2022 with a defined postoperative hospital policy. Cohort 3 ( n = 202) was defined as patients treated between 2022 and 2024 under an expedited recovery after surgery (ERAS) protocol. One patient was excluded as an outlier for an abnormal length of stay (LOS) >190 days. One-way analysis of variance (ANOVA) and post-hoc Tukey’s test were used compare various parameters. Results: Implementation of an ERAS protocol significantly reduced LOS when compared with a standard hospital policy (mean 3.53 days versus 4.55 days, p = 0.0031) and no formal policy (mean: 3.53 vs. 4.98 days, p ≤ 0.0001). Incidence of intra-operative CSF leak was 49% (Cohort 1), 47% (Cohort 2), and 39% (Cohort 3). Use and duration of intraoperative lumbar drain was 12% with mean 4.52 days (Cohort 1), 14% with mean 5.1 days (Cohort 2), and 9% with mean 4.67 days (Cohort 3). Readmission rates reduced with implementation of formal hospital policy (16 vs. 18%), and more-so with an ERAS protocol (8%). Conclusion: An ERAS protocol significantly reduced LOS with a reduction in readmission rate in this patient population, suggesting that expeditious perioperative discharge may reduce healthcare costs while simultaneously improving patient safety. Publication History Article published online: 07 February 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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