2026 Proffered Presentations
S279: ENHANCED RECOVERY PROTOCOLS REDUCE LENGTH OF STAY AND READMISSION RATE AFTER ENDOSCOPIC ENDONASAL RESECTION OF PITUITARY ADENOMAS
Carter M Suryadevara, MD; Rajeev Sen, MD; Akshay Save, MD; Kristen Marciniuk; Richard Lebowitz; Seth Lieberman; Carlos Pinheiro-Neto; Dimitris Placantonakis; Chandra Sen; John Golfinos; Donato Pacione; NYU Langone Health
Introduction: Expedited recovery after surgery (ERAS) protocols have been shown to improve healthcare value and patient outcomes by reducing length of stay without increasing readmission rate after craniotomy. There is a paucity of large-scale data analyses and long-term outcomes evaluating ERAS protocols after endoscopic endonasal resection for pituitary adenomas.
Methods: We performed a retrospective study comprised of data obtained from the electronic medical record (EMR) at our institution. A total of 694 patients who underwent an EEA for resection of primary or recurrent pituitary adenoma between 2012-2025 were included. Of these patients, those with LOS >7 days were excluded as outliers. A total of 624 patients were then categorized into 4 separate cohorts. Cohort 1 (n=147) represented patients treated between 2012-2018 with no formal post-operative hospital policy. Cohort 2 (n=202) represented patients treated between 2018-2022 with a defined post-operative hospital policy. Cohort 3 (n=231) represented patients treated between 2022-2024 under an expedited recovery after surgery (ERAS) protocol. Cohort 4 (n=44) represented patients treated in 2025 with ERAS protocol and a target discharge of post operative day 1. One-way analysis of variance (ANOVA) and post-hoc Tukey’s test were used to compare various parameters.
Results: An ERAS protocol significantly reduced LOS when compared to a standard hospital policy (Cohort 3 vs. Cohort 2, mean 2.84 days vs. 3.74 days, p < 0.0001) and no formal policy (Cohort 3 vs. Cohort 1, mean 2.84 days vs. 4.19 days, p < <0.0001). Importantly, implementing a target discharge of post operative day 1 to the ERAS protocol did not significantly change LOS (Cohort 4 vs. Cohort 3, mean 2.61 days vs. 2.84 days, p = 0.74). Median LOS, however, was reduced by 1 day (Cohort 4 vs. Cohort 3, median 3 days vs. 2 days). Of 594 patients for whom data was available (including LOS outliers), 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%). Data was not yet available for Cohort 4.
Conclusion: Implementation of an ERAS protocol significantly reduced LOS with a reduction in readmission rate. Target discharge of post operative day 1 did not have a statistically significant impact on LOS, but median LOS was reduced by 1 day. Overall, these data suggest that expeditious peri-operative discharge may be a safe maneuver to improve patient outcomes.