TO THE EDITOR: We enjoyed the paper written by Mr. Yu and co-authors1under Drs. Farrell and Evans’s tutelage (Yu S, Taghvaei M, Collopy S, et al. Evaluation of early postoperative day 1 discharge after endoscopic endonasal pituitary adenoma resection.J Neurosurg. Published online October 15, 2021. doi:10.3171/2021.5.JNS2185). We agree that discharge on postoperative day 1 (POD 1) following pituitary adenoma resection should be the norm and not the exception, as in our recent paper published inMayo Clinic Proceedings我们报道,82%的豆荚1放电君威rdless of endoscopic or microscopic approach in a large cohort overlapping with this study. The average length of stay in our study was 1.3 ± 0.04 days; in 78% of the microscopic and 85% of the endoscopic pituitary adenoma cases, the patients were discharged on POD 1.2Compared to the POD 1 group from this paper, our overall 30-day readmission rates were similar for the whole group, at 3.4%.2In this current paper focusing on patient factors associated with successful early discharge, we did not see a well-delineated description of perhaps the most important piece of the puzzle—namely engaged outpatient endocrine support.
我们的实践是一个多学科小组练习with interconnected specialty teams. What is critical to success of our POD 1 discharges is a 24-hour call-in service from neurosurgery, ENT, and endocrinology specialties as well as quality, clear communication to the patient about the postoperative plan. We have found it critical to have an engaged endocrinology group that evaluates the patients as outpatients on POD 1. This early follow-up further informs management of urgent postoperative endocrine issues such as diabetes insipidus and adrenal insufficiency. Additionally, this visit provides an opportunity for important postoperative education and ensures that follow-up laboratory tests and imaging are ordered. We would welcome the authors to expand upon this paper by describing how endocrine support had changed over the course of their study and how it plays a role in allowing for early discharge. In the end we believe that safe discharge of patients can occur on POD 1 regardless of intraoperative CSF leaks or functional tumor status—however, diabetes insipidus may impact early discharge in all studies. In order to get from 48% to 82% of patients dismissed on POD 1, the key is an integrated outpatient plan to manage these patients.
Disclosures
Dr. Bancos is a consultant for HRA Pharma, Corcept, Recordati, Sparrow, Spruce, and Adrenas.
References
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1 ↑
YuS,TaghvaeiM,CollopyS,et al.Evaluation of early postoperative day 1 discharge after endoscopic endonasal pituitary adenoma resection.J Neurosurg. Published online October 15, 2021.doi:10.3171/2021.5.JNS2185
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2 ↑
Van GompelJJ,AtkinsonJLD,ChobyG,et al.Pituitary tumor surgery: comparison of endoscopic and microscopic techniques at a single center.Mayo Clinic Proc.2021;96(8):2043–2057.
