Enhanced Recovery Protocols Reduce Length of Stay and Readmission Rate After Endoscopic Endonasal Resection of Pituitary Adenomas

Introduction: Expedited recovery after surgery (ERAS) protocols have been shown to improve healthcare value and patient outcomes by reducing length of stay without increasing readmission rate after craniotomy. There is a paucity of large-scale data analyses and long-term outcomes evaluating ERAS protocols after endoscopic endonasal resection for pituitary adenomas. Methods: We performed a retrospective study comprised of data obtained from the electronic medical record (EMR) at our institution. A total of 694 patients who underwent an EEA for resection of primary or recurrent pituitary adenoma between 2012–2025 were included. Of these patients, those with LOS >7 days were excluded as outliers. A total of 624 patients were then categorized into 4 separate cohorts. Cohort 1 ( n = 147) represented patients treated between 2012–2018 with no formal post-operative hospital policy. Cohort 2 ( n = 202) represented patients treated between 2018–2022 with a defined post-operative hospital policy. Cohort 3 ( n = 231) represented patients treated between 2022–2024 under an expedited recovery after surgery (ERAS) protocol. Cohort 4 ( n = 44) represented patients treated in 2025 with ERAS protocol and a target discharge of post operative day 1. One-way analysis of variance (ANOVA) and post-hoc Tukey’s test were used to compare various parameters. Results: An ERAS protocol significantly reduced LOS when compared with a standard hospital policy (Cohort 3 versus Cohort 2, mean 2.84 days versus 3.74 days, p < 0.0001) and no formal policy (Cohort 3 versus Cohort 1, mean 2.84 days versus 4.19 days, p <