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J Neurol Surg B Skull Base 2022; 83(06): 618-625
DOI: 10.1055/s-0042-1750718
Review Article

The Cost Effectiveness of Implementation of a Postoperative Endocrinopathy Management Protocol after Resection of Pituitary Adenomas

Carolina G. Benjamin
1   Department of Neurosurgery, University of Miami, Miami, Florida, United States
,
Yosef Dastagirzada
2   Department of Neurosurgery, NYU Langone Medical Center, New York, New York, United States
,
Julia Bevilacqua
2   Department of Neurosurgery, NYU Langone Medical Center, New York, New York, United States
,
David B. Kurland
2   Department of Neurosurgery, NYU Langone Medical Center, New York, New York, United States
,
Kevin Fujita
3   Department of Neurosurgery, Yale Medical Center, New Haven, Connecticut, United States
,
Chandra Sen
2   Department of Neurosurgery, NYU Langone Medical Center, New York, New York, United States
,
John G. Golfinos
2   Department of Neurosurgery, NYU Langone Medical Center, New York, New York, United States
,
Dimitris G. Placantonakis
2   Department of Neurosurgery, NYU Langone Medical Center, New York, New York, United States
,
Jafar J. Jafar
2   Department of Neurosurgery, NYU Langone Medical Center, New York, New York, United States
,
Seth Lieberman
4   Department of Otolaryngology, NYU Langone Medical Center, New York, New York, United States
,
Richard Lebowitz
4   Department of Otolaryngology, NYU Langone Medical Center, New York, New York, United States
,
Ariane Lewis
2   Department of Neurosurgery, NYU Langone Medical Center, New York, New York, United States
5   Department of Neurology, NYU Langone Medical Center, New York, New York, United States
,
Nidhi Agrawal
6   Department of Endocrinology, NYU Langone Medical Center, New York, New York, United States
,
Donato Pacione
2   Department of Neurosurgery, NYU Langone Medical Center, New York, New York, United States
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Abstract

Purpose After developing a protocol for evaluating, diagnosing, and treating postoperative endocrinopathy both during the hospitalization and during the immediate discharge period following resection of pituitary adenomas, we sought to assess the impact of this protocol on quality outcomes.

Methods An IRB-exempt, quality improvement initiated, Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective comparison of a pre-and-post-protocol cohort of all patients undergoing endoscopic endonasal resection of pituitary adenomas at NYU Langone Medical Center from January 2013 to December 2018. Demographic characteristics of the patients and their tumors with their postoperative outcomes were recorded. Quality outcomes regarding number of laboratory studies sent, rate of diabetes insipidus, length of stay, and readmission rate were also recorded. Statistical analysis was performed between the pre- and post-protocol groups.

Results There was a significant reduction in laboratory studies sent per patient (55.66 vs. 18.82, p <0.001). This corresponded with an overall cost reduction in laboratory studies of $255.95 per patient. There was a decrease in the overall number of patients treated with DDAVP (21.4% in the pre-protocol group vs. 8.9% in the post-protocol group, p = 0.04). All post-protocol patients requiring DDAVP at discharge were identified by 48 hours. There was no significant change in length of stay or need for hydrocortisone supplementation postoperatively between the two groups. Length of stay was driven mostly by need for reoperation during initial hospitalization. There was no significant change in the rate of 30-day readmission.

Conclusion Implementation of a postoperative management protocol results in a more efficient diagnosis and management of endocrinopathy after pituitary adenoma surgery which translates to decreased cost.

Keywords

pituitary adenoma - endoscopic endonasal surgery - quality improvement - safety - cost effectiveness

Note

Portion of this work was presented at the NASBS Meeting in Orlando, Florida.


Supplementary Material



Publication History

Received: 07 October 2021

Accepted: 23 May 2022

Article published online:
29 June 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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