CLINICAL PRACTICE PATTERNS FOR POSTOPERATIVE WATER BALANCE AFTER PITUITARY SURGERY

Area of Science:

• Endocrinology
• Neurosurgery
• Clinical Practice Guidelines

Background:

• Water and sodium balance abnormalities, such as diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone (SIADH), are frequent complications following transsphenoidal surgery.
• Current postoperative monitoring and management practices for these complications are inconsistent, lacking established consensus guidelines.

Purpose of the Study:

• To identify and compare current clinical practice patterns for the evaluation and management of postoperative water and sodium balance abnormalities after transsphenoidal surgery.

Main Methods:

• A questionnaire was distributed to members of the Pituitary Society, an international organization focused on pituitary disease.
• The survey collected demographic data and information on postoperative practice habits related to DI and SIADH.
• Eighty-six international respondents, primarily from academic institutions and multidisciplinary teams, completed the survey.

Main Results:

• Significant differences in practice patterns were observed based on geographic location: American practitioners reported shorter postoperative length of stay (LOS) and more restrictive fluid recommendations for SIADH compared to non-American practitioners.
• Early-career clinicians (less than 10 years of experience) checked the first postoperative sodium level earlier than later-career clinicians.
• Overall clinical experience did not significantly impact practice habits, but practice location influenced LOS and SIADH fluid restriction.

Conclusions:

• Water and sodium dysregulation are common and poorly standardized issues post-transsphenoidal surgery.
• Practice patterns vary, particularly influenced by geographic location, highlighting a need for evidence-based guidelines.
• Further research is warranted to establish standardized protocols for managing these common postoperative complications.