{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T09:06:06Z","timestamp":1779527166042,"version":"3.53.1"},"reference-count":96,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The aim of this study was to report the authors\u2019 experience developing a Lean Six Sigma clinical care pathway (CCP) for endoscopic endonasal transsphenoidal operations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Using Lean Six Sigma quality improvement principles\u2014including the define, measure, analyze, improve, and control framework\u2014the authors developed a CCP for endoscopic endonasal transsphenoidal operations, incorporating preoperative, intraoperative, and inpatient and outpatient postoperative phases of care. Efficacy and quality metrics were defined as postoperative length of stay (LOS), presentation to the emergency department (ED) or readmission within 30 days of discharge, and hospital charges. The study included all adult patients who underwent elective endoscopic endonasal resection for pituitary adenoma, Rathke\u2019s cleft cyst, craniopharyngioma, pituicytoma, or arachnoid cyst during the sampling period (April 1, 2018, to December 31, 2022).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Two hundred twenty-eight patients met criteria and were included; 94 were treated before and 134 were treated after implementation of the CCP. Differences between groups in age, gender, race, BMI, American Society of Anesthesiologists classification, geographic distribution, preoperative serum sodium, tumor size, adenoma functional status, and prior surgery were not significant. The mean postoperative LOS significantly decreased from 4.5 to 1.7 days following CCP implementation (p &lt; 0.0001); LOS variability also decreased, with the standard deviation declining from 3.1 to 1.5 days. The proportion of patients discharged on postoperative day (POD) 1 significantly increased from 0% to 61.9% (p &lt; 0.0001). Fewer than one-quarter of the patients (23.4%) were discharged by POD 2 prior to the CCP, while 88.8% of were discharged by POD 2 after CCP implementation (p &lt; 0.0001). Rates of 30-day ED presentations or readmissions were not significantly different (2.1% vs 6.0%, p = 0.20, and 7.5% vs 6.7%, p &gt; 0.99, respectively). Mean per-patient hospital costs declined from $38,326 to $26,289 (p &lt; 0.0001), with an associated change in cost variability from a standard deviation of $16,716 to $12,498.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>CCP implementation significantly improved LOS and costs of endoscopic endonasal resection, without adversely impacting postoperative ED presentations or readmissions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2023.9.focus23545","type":"journal-article","created":{"date-parts":[[2023,12,7]],"date-time":"2023-12-07T10:00:44Z","timestamp":1701943244000},"page":"E10","source":"Crossref","is-referenced-by-count":3,"title":["An institutional experience in applying quality improvement measures to pituitary surgery: clinical and resource implications"],"prefix":"10.3171","volume":"55","author":[{"given":"Panayiotis E.","family":"Pelargos","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aamr","family":"Hasanjee","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2013Head and Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Lee","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrey","family":"Grossen","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiana Y.","family":"Prather","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaochun","family":"Zhao","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prince","family":"Ohene-Nyako","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2013Head and Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew P.","family":"Baier","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda Kate","family":"McDaniel","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kibwei A.","family":"McKinney","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2013Head and Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher S.","family":"Graffeo","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"El Rassi","sequence":"additional","affiliation":[{"name":"Otolaryngology\u2013Head and Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian F.","family":"Dunn","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"suppl 5","key":"b1","series-title":"Neuro Oncol","first-page":"v1","article-title":"CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2015-2019","volume":"24","author":"Ostrom QT","year":"2022","unstructured":"Ostrom QT, Price M, Neff C,  CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2015-2019. 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