Pituitary Perioperative Care Management Survey Do you use IV antibiotics at time of surgery and if so which type (assuming no allergies)? No antibiotics 1st generation cephalosporin (e.g. cefazolin) 3rd/4th gen cephalosporin and/or vancomycin Other IV antibiotic How do you routinely use post-op antibiotics after any IV antibiotics? No postop oral antibiotics Oral antibiotics only if we place any packing (absorbable or non-absorbable) Oral antibiotics only if we place non-absorbable packing Oral antibiotics in all patients Do you use packing and how long do you leave it in place: 1. Highflow >1cm dura effect No packing Absorbable packing Nonabsorbable packing less than 3 days Nonabsorbable packing 3-5 days Nonabsorbable packing 7 days or more Do you use packing and how long do you leave it in place: 2. Highflow or </+ 1cm dura effect No packing Absorbable packing Nonabsorbable packing less than 3 days Nonabsorbable packing 3-5 days Nonabsorbable packing 7 days or more Do you use packing and how long do you leave it in place: 3. Lowflow leak No packing Absorbable packing Nonabsorbable packing less than 3 days Nonabsorbable packing 3-5 days Nonabsorbable packing 7 days or more Do you routinely use a Foley urinary catheter? No, not routinely placed Yes, placed in OR to monitor fluid balance, removed in OR Yes, placed in OR and maintained <24hr postop to monitor fluid balance Yes, placed in OR and maintained >24hr or when patient mobilizes to monitor fluid balance Do you send patients to the ICU post-op? Always If there is a CSF leak If they are high risk or medically complex Never DI management and sodium monitoring: 1. Do you routinely discharge patients with fluid restriction? Yes No DI management and sodium monitoring: 2. Do you routinely check a BMP in follow-up postop? No specific algorithm Ask patient to call with symptoms of delayed hyponatremia Clinical team routinely calls patient to inquire about symptoms of delayed hyponatremia Routine short-term follow-up at 1 week by surgical team or endocrinology to decide Routine BMP drawn around POD7 DI management and sodium monitoring: 3. Use of salt tablets at discharge? Never use salt tablets Routinely use salt tablets in patients post-op Please describe your routine post-operative activity progression – No CSF leak intraop: No bedrest, mobilize ad lib Bedrest for 24 hours or less and then mobilize ad lib Bedrest >24hr, then mobilize ad lib Please describe your routine post-operative activity progression – Low flow CSF leak intraop: No bedrest, mobilize ad lib Bedrest for 24 hours or less and then mobilize ad lib Bedrest >24hr, then mobilize ad lib Please describe your routine post-operative activity progression – High flow CSF leak intraop: No bedrest, mobilize ad lib Bedrest for 24 hours or less and then mobilize ad lib Bedrest >24hr, then mobilize ad lib Duration off CPAP if no CSF leak intraop: Start right way <1 week 1-2 weeks 2-4 weeks >4 weeks Duration off CPAP if CSF leak intraop: Start right way <1 week 1-2 weeks 2-4 weeks >4 weeks Non- Cushing hydrocortisone management for patients with NORMAL preop cortisol: Provide replacement for everyone immediately postop Assess patient cortisol POD 1 and replace accordingly Assess patient cortisol POD 1 and/or 2 and replace accordingly No replacement unless symptoms develop EmailThis field is for validation purposes and should be left unchanged.
