Barrette Louis-Xavier, Douglas Jennifer, Chorath Kevin T, Shah Mitali, Lu Joseph, Newman Jason G, Adappa Nithin, Kohanski Michael, Palmer James, Yoshor Daniel, Lee John, White Caitlin A, Kharlip Julia, Rajasekaran Karthik
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA.
J Craniofac Surg. 2023;34(1):83-91. doi: 10.1097/SCS.0000000000008893. Epub 2022 Aug 15.
To identify key recommendations for maximizing the efficiency and efficacy of perioperative care in transsphenoidal pituitary surgery.
The authors performed a comprehensive literature search of Enhanced Recovery After Surgery protocols implemented for patients undergoing transsphenoidal adenomectomy (TSA); individual recommendations were abstracted, and the evidence base thoroughly reviewed.
The authors identified 19 individual recommendations pertinent to the care of patients undergoing TSA, which were subdivided into preoperative (n=6), intraoperative (n=6), and postoperative (n=7) interventions. Key factors recommended for minimizing length of stay, preventing readmission, and improving patient outcomes included comprehensive patient education, multidisciplinary evaluation, avoidance of routine lumbar drain placement and nasal packing, and rigorous postoperative monitoring of pituitary function and salt-water imbalances. The overall level of evidence for 7/19 (37%) implemented recommendations was found to be low, suggesting a need for continued research in this patient population.
Several key interventions should be considered in the development of Enhanced Recovery After Surgery protocols for TSA, which may aid in further decreasing length of stay and promoting positive patient outcomes.
确定提高经蝶窦垂体手术围手术期护理效率和效果的关键建议。
作者对为行经蝶窦腺瘤切除术（TSA）患者实施的术后加速康复方案进行了全面的文献检索；提取了各项建议，并对证据基础进行了全面审查。
作者确定了19项与TSA患者护理相关的具体建议，这些建议被细分为术前（n = 6）、术中（n = 6）和术后（n = 7）干预措施。为尽量缩短住院时间、防止再次入院和改善患者预后而推荐的关键因素包括全面的患者教育、多学科评估、避免常规放置腰大池引流管和鼻腔填塞，以及对垂体功能和盐水失衡进行严格的术后监测。发现19项已实施建议中有7项（37%）的总体证据水平较低，表明需要对该患者群体继续进行研究。
在制定TSA术后加速康复方案时应考虑若干关键干预措施，这可能有助于进一步缩短住院时间并促进患者获得良好预后。
