Endocrine Abstracts

Background: The recent Get It Right First Time (GIRT) report suggests short stay pathways should be aimed for in pituitary surgery in England, with 1–2 days being realistic. We prospectively audited the length of stay (LOS) for patients undergoing transsphenoidal surgery (TSS) for sellar and suprasellar lesions at the Royal Victoria infirmary hospital (RVI) over a 2-year period, from October 2019.

Methods: Data was prospectively collected for each patient: demographics, LOS, post-operative complications.

Results: 78 patients underwent TSS during the audit period, with a mean LOS of 9.4 days. 31% of patients suffered a post-operative CSF leak and 45% experienced post-operative serum sodium imbalances. Patients with craniopharyngioma had a longer LOS compared to those with benign pituitary tumours (13.3 vs. 8.8 days). Rates of post-operative CSF leaks were higher in patients with Cushing’s disease (50%) but post-operative sodium imbalances occurred most frequently in patients with craniopharyngioma (70%). The mean LOS, for two-thirds of patients with non-functioning pituitary adenomas or acromegaly with no post-operative complications, was 5 days. Older patients (aged >60 years) were more likely to have longer LOS at 12 days (vs. 6 days) and were more likely to suffer from post-operative CSF leak (38% vs. 18%) and electrolyte imbalances (38% vs. 21%). Patients on four or more regular medications, a marker of comorbidities, stayed 1.5 times longer in hospital than those on less regular medications. On average, post-operative sodium imbalances occurred 2 days after surgery and took 7 days to resolve.

Conclusions: LOS for patients undergoing TSA for sellar and suprasellar lesions is influenced by the etiology of the lesion, age of the patient, existing comorbidities and post-operative complications. Younger patients with non-functioning pituitary adenoma or acromegaly should be the more realistic cohort to aim for shorter LOS.