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- Title
Feasibility, safety, and outcomes of a stratified fast-track care trajectory in pituitary surgery.
- 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.
- Abstract
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.
- Publication
Endocrine (1355008X), 2020, Vol 69, Issue 1, p175
- ISSN
1355-008X
- Publication type
Article
- DOI
10.1007/s12020-020-02308-2