Feasibility, safety, and outcomes of a stratified fast-track care trajectory in pituitary surgery

• Published in: Endocrine Vol. 69; no. 1; pp. 175 - 187
• Main Authors: Lobatto, Daniel J., Vliet Vlieland, Thea P. M., van den Hout, Wilbert B., de Vries, Friso, de Vries, Anne F., Schutte, Pieter J., Verstegen, Marco J. T., Pereira, Alberto M., Peul, Wilco C., Biermasz, Nienke R., van Furth, Wouter R.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.07.2020; Springer Nature B.V
• Subjects: Brain tumors; Costs; Diabetes; Endocrinology; Humanities and Social Sciences; Internal Medicine; Medicine; Medicine & Public Health; multidisciplinary; Original; Original Article; Patients; Pituitary; Science; Surgery; Surveillance; Fast-track care trajectory; Feasibility and safety; Value Based Health Care; Endoscopic transsphenoidal surgery; Pituitary adenoma
• ISSN: 1355-008X; 1559-0100
• DOI: 10.1007/s12020-020-02308-2

Objective Discharge policies concerning hospitalization after endoscopic pituitary tumor surgery are highly variable. A few studies support fast-track discharge; however, this is not commonplace. Our goal was to report the transition to and evaluate the feasibility, safety, clinical- and patient-reported outcomes and costs of fast-track care in pituitary surgery. Methods This observational study included 155 patients undergoing pituitary surgery between December 2016 and December 2018. Fast-track care consisted of planned discharge 2–3 days after surgery, followed by daily surveillance by a case manager. All outcomes were compared with patients not eligible for fast-track discharge. The total group (fast-track and non-fast-track) was compared with historic controls ( N  = 307). Results A total of 79/155 patients (51%) were considered eligible for fast-track discharge, of whom 69 (87%) were discharged within 3 days. The total group was discharged more often within 3 days compared with historic controls (49 vs. 20%, p  < 0.001), the total length of stay did not differ (5.3 vs. 5.7 days, p  = 0.363). Although the total group had more readmissions compared with historic controls (17 vs. 10%, p  = 0.002), no life-threatening complications occurred after discharge. On average, clinical- and patient-reported outcomes improved over time, both in the fast-track and non-fast-track groups. The mean overall costs within 30 days after surgery did not differ between the total group € 9992 (SD € 4562) and historic controls € 9818 (SD € 3488) ( p  = 0.649). Conclusion A stratified fast-track care trajectory with enhanced postoperative outpatient surveillance after pituitary tumor surgery is safe and feasible. As expected, costs of the fast-track were lower than the non-fast-track group, however we could not prove overall cost-effectiveness compared with the historic controls.