The Cost Effectiveness of Implementation of a Postoperative Endocrinopathy Management Protocol after Resection of Pituitary Adenomas.
The Cost Effectiveness of Implementation of a Postoperative Endocrinopathy Management Protocol after Resection of Pituitary Adenomas.
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垂体腺瘤切除术后实施术后内分泌病管理方案的成本效益。
DOI：
10.1055/s-0042-1750718
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Pacione,Donato
中科院分区：
文献类型：
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作者：
Benjamin,CarolinaG;Dastagirzada,Yosef;Bevilacqua,Julia;Kurland,DavidB;Fujita,Kevin;Sen,Chandra;Golfinos,JohnG;Placantonakis,DimitrisG;Jafar,JafarJ;Lieberman,Seth;Lebowitz,Richard;Lewis,Ariane;Agrawal,Nidhi;Pacione,Donato
目的：在制定了评估、诊断和治疗垂体腺瘤切除术后住院和出院期间的术后内分泌病的方案后，我们试图评估该方案对质量结果的影响。方法：2013年1月至2018年12月在纽约大学朗格尼医学中心接受垂体腺瘤内镜下鼻内切除术的所有患者的回顾性比较研究，该研究符合irb豁免、质量改进倡议、健康保险可移植性和责任法案（HIPAA）的要求。记录患者及其肿瘤的人口学特征及术后预后。还记录了发送的实验室研究数量、尿崩症发生率、住院时间和再入院率的质量结果。对方案前后两组进行统计学分析。结果每位患者发送的实验室研究显著减少（55.66比18.82,p< 0.001）。这相当于每位患者在实验室研究方面的总成本降低了255.95美元。接受DDAVP治疗的患者总数有所减少（方案前组为21.4%，方案后组为8.9%,p= 0.04）。所有在出院时需要DDAVP的方案后患者在48小时内被确定。两组患者的住院时间和术后补充氢化可的松的必要性没有显著变化。住院时间的长短主要取决于初次住院期间是否需要再手术。30天再入院率无显著变化。结论术后管理方案的实施可提高垂体腺瘤术后内分泌病的诊断和管理效率，降低手术费用。
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.