Adjustment of Surgical Technique Lowers Readmission for Epistaxis in Endoscopic Pituitary Surgery

Objective To examine the rates and health care costs of readmission for epistaxis before and after implementation of a novel surgical technique, the nasoseptal rescue flap, for repair of large sellar defects following endoscopic pituitary surgery.

Design Retrospective chart review of patients who underwent transnasal, transsphenoidal pituitary surgery at a tertiary care hospital from April 2006 to March 2017.

Methods Examined rates of readmission in the 30-day postoperative periods for epistaxis events before and after implementation of the nasoseptal rescue flap in November 2012. Events were categorized as either major or minor. A major event was defined as a bleed requiring surgery or IR embolization for control. A minor event was defined as a bleed that was managed with packing, Floseal, or observation without intervention.

Results A total of 608 patients who had endoscopic pituitary surgery were examined; 376 were operated on before the implementation of the rescue flap and 233 after. Prior to rescue flap implementation, there were seven (1.86%) patients who required readmission for epistaxis with five (1.33%) major bleeding events and two minor (0.53%). After rescue flap implementation, there were three (1.28%) epistaxis event requiring readmission, all minor.

Conclusion Implementation of the nasoseptal rescue flap resulted in a trend toward decreased readmission rates for all epistaxis events and a significant decrease in readmission for major epistaxis events. The use of this surgical technique therefore has the potential to provide substantial savings in health care costs.