2026 Proffered Presentations
S043: FEASIBILITY OF DAY 1 POST-OPERATIVE DISCHARGE FOLLOWING ELECTIVE PITUITARY ADENOMA RESECTION - A 6 YEAR SINGLE INSTITUTION EXPERIENCE AND COMPARISON TO UK NATIONAL PITUITARY DATA OF 3,607 CASES.
Christopher Yusuf Akhunbay-Fudge; Eyad Darraj; Asim Sheikh; Nick Phillips; Atul Tyagi; Paul Nix; Leeds General Infirmary
Objective: The length of stay (LOS) and 30 day re-admission rates are important surgical metrics following endonasal transsphenoidal surgery (ETS) for pituitary adenoma. From November 2017, in our institution, we initiated a post-operative day 1 (POD1) discharge policy for elective pituitary adenoma patients undergoing ETS. The authors reviewed their single institution experience of the new policy over a 6 year period and compared local results to the UK national data.
Methods: Local data is stored on a prospectively maintained database of all endoscopic procedures. All elective pituitary adenomas undergoing ETS were reviewed for the time period from January 2018 to June 2024. Retrospective case note analysis was undertaken for additional information for any LOS greater than 1 day. National data was obtained from the National Consultant information Portal (NCIP) from NHS England.
Results: A total of 215 elective pituitary ETS cases were performed in our institution over the study period. The POD1 discharge rate was 49.8% (n=107). Stratifying by LOS, the mean age of patients discharged on POD1 was 54.8, with 43.9% (n=47) being female. The intra-operative CSF leak rate was 20.6% (n=22) with a 30 day re-admission rate of 10.3% (n=11). The post-operative CSF leak rate needing readmission and return to theatre (RTT) was 0.93% (n=1). For patients discharged on POD>1, the mean age was 56.7, with 54.6% (n=59) being female. The intra-operative CSF leak rate was 34.9% (n=38) with a 30 day re-admission rate of 13% (n=14). The post-operative CSF leak rate needing RTT was 2.78% (n=3). The commonest reason for re-admission across both groups was sodium abnormalities (n=9). The commonest reasons for increased LOS were sodium abnormalities and/or post-operative polyuria at 38% (n=41). Multiple logistic regression analysis showed a significant association between increased LOS and intra-operative CSF leak (Odds ratio 2.3, p<0.05). There was no significant association with age, gender or histology (i.e functioning vs non-functioning adenoma). Over the same time period 3,607 pituitary procedures were performed nationally. In the national data only LOS>3 data is collected and this was 56.81% (n=2,049) of admissions compared to 14.88% (n=32) in our data. The overall national CSF leak rate was 14.03% and the 30 day readmission rate was 11.26%. Of the total national procedures, 91.35% were elective procedures and 93.48% were endoscopic. Assuming a daily hospital bed cost of approximately £400, we estimate a minimum cost saving of £42,800 with a conservative estimate of 1 day in hospital saved for the 107 patients discharged on POD1 at our hospital.
Conclusion: Our single institution experience of discharging patients on POD1 appears safe, feasible and cost-effective. The 30 day re-admission rate is comparable to the national data and we have experienced no morbidity or mortality to date, suggesting no significant detrimental effect since initiation of the policy. This system is dependent on a safety network including patient/carer education and streamlined ward access if there are any concerns. We advocate consideration of adopting a similar early discharge strategy internationally to streamline patient experiences and improve cost saving measures.