Factors Associated with 30-Day Readmission after Endoscopic Endonasal Transsphenoidal Resection of Sellar Lesions

Background: The objective of this study was to identify factors associated with unplanned 30-day readmissions following endoscopic transsphenoidal pituitary surgery.

Methods: A single-institution retrospective chart review was performed from January 2015 to 2019 for patients undergoing endoscopic transsphenoidal resection of sellar lesions.

Results: A total of 297 patients (n = 161 female) underwent transsphenoidal surgery for sellar lesions. The majority of patients were white (n = 253) and the median age was 54 years (range: 18–85). Of the 297 patients, 42 (14.1%) patients had unplanned readmission within 30 days. Of the 42 patients, 24 (57%) were female, 38 were white (90%) and the median age was 54 years (range: 25–84 years). The most common tumor was a nonfunctioning pituitary adenoma (n = 18). The median time to readmission was 5.5 days (range: 1–30 days). The most common cause of readmission was hyponatremia (n = 18), followed by CSF leak (n = 5), epistaxis (n = 4), adrenal insufficiency (n = 3), infection (n = 4), headache (n = 3), recurrent Cushing's (n = 2), syncope (n = 2), and dyspnea (n = 1). For patients presenting with hyponatremia, the median time to presentation was 4.5 days after discharge (range: 1–11 days). The median sodium value on readmission was 128 mEq/L (range: 121–134 mEq/L) compared with a median sodium value on discharge of 141 mEq/L (range: 133–146 mEq/L) with a median decrease of −13 mEq/L (range: −4 to −22 mEq/L).

Discussion: In our single-institution study, we identified hyponatremia as the most common cause of 30-day readmission. Most patients with hyponatremia on readmission presented within 1 week of discharge. The median drop in sodium was 13 mEq/L on readmission, suggesting that a trend of downtrend sodium values should trigger a closer monitoring and correction of hyponatremia to prevent readmission.

Publication History

Article published online:
12 February 2021