Optimizing Perioperative Care in Transsphenoidal Pituitary Surgery: Considerations for Enhanced Recovery After...

Area of Science:

• Neurosurgery
• Endocrinology
• Surgical Oncology

Background:

• Transsphenoidal adenomectomy (TSA) is a common procedure for pituitary tumors.
• Optimizing perioperative care is crucial for patient recovery and outcomes.
• Enhanced Recovery After Surgery (ERAS) protocols aim to standardize and improve surgical care pathways.

Purpose of the Study:

• To identify key recommendations for enhancing perioperative care in transsphenoidal pituitary surgery.
• To inform the development of evidence-based Enhanced Recovery After Surgery protocols for TSA.

Main Methods:

• A comprehensive literature search was conducted on ERAS protocols for transsphenoidal adenomectomy.
• Individual recommendations were abstracted and the supporting evidence was reviewed.
• Recommendations were categorized into preoperative, intraoperative, and postoperative interventions.

Main Results:

• Nineteen recommendations were identified for TSA perioperative care.
• Key factors for improved outcomes include patient education, multidisciplinary evaluation, avoiding routine lumbar drains and nasal packing, and monitoring pituitary function and electrolytes.
• A low level of evidence (37%) supports many current recommendations, highlighting the need for further research.

Conclusions:

• Implementing specific interventions within ERAS protocols can optimize perioperative care for TSA.
• These strategies may lead to reduced hospital stays and improved patient outcomes.
• Further research is needed to strengthen the evidence base for ERAS in pituitary surgery.