(CSEMP067) QUALITY IMPROVEMENT INITIATIVE TO ENHANCE PERIOPERATIVE CARE AND MONITORING AFTER PITUITARY SURGERY

Abstract:

Background: The pituitary gland plays a critical role in regulating various hormones. Following pituitary surgery, patients may develop hormone abnormalities, including syndrome of inappropriate antidiuretic hormone and central adrenal insufficiency. These complications could lead to hospital readmissions, morbidity and even mortality without early recognition and prompt treatment. Current endocrine guidelines recommend outpatient sodium and cortisol monitoring on postoperative day 7 (POD7) and comprehensive pituitary function assessment around 6 weeks post-surgery (POW6). However, there is currently no standardized postoperative protocol in place at our local tertiary care hospital, and it is unclear how often the recommended bloodwork is being performed at our hospital.

Objectives: To evaluate the frequency of outpatient bloodwork on POD7 and POW6, before and after implementation of a standardized endocrine discharge protocol.

Methods: Through collaboration with relevant stakeholders and using quality improvement tools, we created a standardized endocrine discharge protocol that included clear patient instructions and pre-filled laboratory requisitions. For the baseline cohort, we retrospectively reviewed all postoperative outpatient bloodwork from all pituitary surgeries at our hospital from September 1, 2021, to August 31, 2022. We then prospectively collected data for all patients who had surgery after the implementation of our protocol starting on January 1, 2023 (intervention cohort). Our main outcome measure was completion of POD7 and POW6 bloodwork. We defined POD7 bloodwork as cortisol or sodium level by POD7, excluding patients who were still admitted on or after POD5, and POW6 bloodwork as cortisol by POD90 and free T4 between POD30-90. We compared outcomes between the two cohorts using statistical process control charts. We also contacted a subset of intervention patients for their feedback on the process and their postoperative experience.

Results: In the baseline cohort, only 17% of patients (9/52) completed POD7 bloodwork, and 52% (28/54) completed POW6 bloodwork. In the intervention phase thus far, this increased to 77% (17/22) for POD7 bloodwork and 75% (12/16) for POW6 bloodwork. Importantly, we found that 35% of intervention patients (6/17) had hyponatremia on POD7. In addition, all 13 interviewed patients expressed high satisfaction and found the discharge instructions to be clear and comprehensive.

Conclusions: The introduction of a standardized endocrine discharge protocol at our tertiary care hospital improved the completion rates of guideline-recommended outpatient bloodwork following pituitary surgery. This improvement is crucial for the early detection and prompt treatment of postoperative endocrine complications.