Enhanced Recovery Following Endoscopic Endonasal Pituitary Surgery: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Objective: To assess the currently available literature regarding enhanced recovery after surgery (ERAS) and similar protocols on length of stay and postoperative complications among patients undergoing endoscopic endonasal resection of pituitary adenomas. Study Design: Embase, Web of Science, Medline, and Google Scholar databases were searched from their respective dates of inception until September 2022 for studies that assessed ERAS protocols among patients undergoing pituitary surgery. The primary outcome of interest was length of stay (LOS) following surgery. Secondary outcomes of interest included total complications, rate of readmission, and postoperative interventions/escalations of care (e.g., ICU, reoperation). Results: Search results yielded 629 studies, from which four studies with a total of 285 patients were included in the final analysis. 166 patients went through an ERAS style protocol. The patients who went through an ERAS protocol had a postoperative LOS of 1.8 days, with 83% of these patients discharged on the first postoperative day. The ERAS cohort had a readmission rate of 4.2%, and nearly half of these readmissions were due to hyponatremia (1.8%). The control groups had a 4.2% and 1.7% overall readmission rate and hyponatremia readmission rate, respectively. There was a significant difference in LOS between the ERAS cohort, 1.8 days, and the control groups, 6.1 days ( p < 0.05). Conclusion: The available literature suggests that selected patients, who participate in ERAS style pathway, can be safely discharged on the first postoperative day following endoscopic endonasal pituitary surgery. Larger, appropriately powered studies would be necessary to understand who the right patients are for such a pathway and if there are greater complications with early postoperative discharge. Level of Evidence: This study presents level 3 evidence as a systematic review of case series and trials without blinding and inconsistently applied reference standards. Publication History Article published online: 01 February 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.016 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.013 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".