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经鼻内镜蝶窦入路垂体瘤切除术:术后加速康复(ERAS)方案中缩短住院时间的首选适应证?一项系统综述。

Endoscopic Endonasal Transsphenoidal Surgery for the Resection of Pituitary Adenomas: A Prime Candidate for a Shortened Length of Stay Enhanced Recovery after Surgery Protocol? A Systematic Review.

机构信息

Department of Neurosurgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.

Department of Neurosurgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA.

出版信息

World Neurosurg. 2024 Jun;186:145-154. doi: 10.1016/j.wneu.2024.03.135. Epub 2024 Mar 27.

Abstract

BACKGROUND

Enhanced Recovery After Surgery (ERAS) is a perioperative model of care aimed at optimizing postoperative rehabilitation and reducing hospital length of stay (LOS). Decreasing LOS avoids hospital-acquired complications, reduces cost of care, and improves patient satisfaction. Given the lack of ERAS protocols for endoscopic endonasal transsphenoidal surgery (EETS) resection of pituitary adenomas, a systematic review of EETS was performed to compile patient outcomes and analyze factors that may lead to increased LOS, reoperation, and readmission rates with the intention to contribute to the development of a successful ERAS protocol for EETS.

METHODS

The authors performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines-based systematic review of the literature. Information was extracted regarding patient LOS, surgery complications, and readmission/reoperation rates. Pearson's correlations to LOS and reoperation/readmission rates were performed with variables normalized to the number of participants. Statistical significance was set at P value <0.05.

RESULTS

Fourteen studies were included, consisting of 2083 patients. The most common complications were cerebrospinal fluid leaks (37%) and postoperative diabetes insipidus (DI) (9%). Transient DI was significantly correlated with shorter LOS. Functional pituitary adenomas were significantly correlated with lower readmission rates while nonfunctional pituitary adenomas were correlated with higher readmission rates. No other factor was found to be significantly correlated with a change in LOS or reoperation rate.

CONCLUSIONS

EETS may be an ideal candidate for the development of ERAS cranial protocols. While our data largely supports the safe implementation of shortened LOS protocols in EETS, our findings highlight the importance of transient DI and nonfunctional pituitary adenomas management when formulating ERAS protocols.

摘要

背景

术后快速康复(ERAS)是一种围手术期护理模式,旨在优化术后康复并缩短住院时间(LOS)。缩短 LOS 可以避免医院获得性并发症、降低医疗成本并提高患者满意度。鉴于内镜经鼻蝶窦入路(EETS)切除垂体腺瘤缺乏 ERAS 方案,我们对 EETS 进行了系统评价,以汇总患者结局并分析可能导致 LOS 延长、再次手术和再入院率增加的因素,旨在为 EETS 的成功 ERAS 方案的制定做出贡献。

方法

作者按照系统评价和荟萃分析报告的首选条目(PRISMA)指南进行了文献系统评价。提取了关于患者 LOS、手术并发症和再入院/再次手术率的信息。对 LOS 和再手术/再入院率与标准化至参与者数量的变量进行 Pearson 相关性分析。统计显著性设置为 P 值<0.05。

结果

纳入了 14 项研究,共 2083 例患者。最常见的并发症是脑脊液漏(37%)和术后尿崩症(DI)(9%)。短暂性 DI 与 LOS 缩短显著相关。功能性垂体腺瘤与较低的再入院率显著相关,而非功能性垂体腺瘤与较高的再入院率相关。未发现其他因素与 LOS 或再次手术率的变化显著相关。

结论

EETS 可能是制定 ERAS 颅底方案的理想候选方案。虽然我们的数据在很大程度上支持在 EETS 中实施缩短 LOS 方案的安全性,但我们的研究结果强调了在制定 ERAS 方案时管理短暂性 DI 和非功能性垂体腺瘤的重要性。

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