Objectives: Reducing length of inpatient stay following trans-sphenoidal pituitary adenectomy (TSA) could create significant financial saving for the NHS. We assessed early complication rates post-TSA to determine feasibility of early hospital discharge (3 days) post-TSA.
Methods: We identified retrospectively 60 patients who underwent TSA at the John Radcliffe Hospital. These consisted of patients with a pre-operative confirmed diagnosis of non-functioning adenoma (NFA, n=20), Cushings disease (n=20) and acromegaly (n=20). Data collected included age, gender, town of residence, length of stay, requirement for hydrocortisone and desmopressin at discharge, serum [Na] excursions and post-operative complications. Data are reported as mean (S.D.). For comparison between sub-groups, the ANOVA test was used.
Results: The NFA sub-group was older than other sub-groups (NFA, 60.9 years (14.3); Cushings, 44.4 years (13.6); acromegaly, 43.7 years (13.4); P<0.0001). There were 30 male and 30 female patients, and 42 patients lived outside Oxfordshire. Average length of in-patient stay was significantly greater for the Cushings sub-group compared to others (NFA, 6.0 days (5.6); Cushings, 12.4 days (11.9); acromegaly, 5.6 days (1.8); P 0.01). Discharge on hydrocortisone therapy was required for NFA (n=15), Cushings (n=18) and acromegaly (n=8); P=0.002. Discharge on desmopressin was required for NFA (n=3), Cushings (n=6) and acromegaly (n=2); P=NS. Serum [Na] excursions in the early post-operative period were equivalent between subgroups (NFA, 2.5 mmol/l (3.5); Cushings, 3.5 mmol/l (3.0); acromegaly, 3.5 mmol/l (3.9); P=NS). Early post-operative complications (including CSF leak, epistaxis, chest infection and need for further surgery) occurred significantly more frequently in the Cushings subgroup (NFA, n=3; Cushings, n=11; acromegaly, n=3; P=0.01).
Conclusions: Our data clearly demonstrate that Cushings patients are significantly more likely to develop early post-operative complications and require longer hospital stay compared with acromegaly and NFA patients. Although our data do not support a policy of early discharge post-TSA in Cushings patients, they do support an audited trial of early post-TSA discharge in patients with NFA and acromegaly.