Audit of Postoperative Readmissions and Patient Messages following Endoscopic Transnasal Transsphenoidal Surgery

Abstract

Objectives The aim of this study was to identify the reasons for patient messages, phone calls, and emergency department (ED) visits prior to the first postoperative visit following discharge after endoscopic transnasal transsphenoidal (eTNTS) surgery.

Design This is a retrospective review of patients at a tertiary care academic center who underwent eTNTS for resection of a sellar region tumor between May 2020 and August 2021. Patient, tumor, and surgical characteristics were collected, along with postoperative, postdischarge, and readmission information. Regression analyses were performed to investigate risk factors associated with postdischarge phone calls, messages, ED visits, and readmissions.

Main Outcome Measures The main outcomes were the number of and reasons for phone calls, patient messages, and ED visits between hospital discharge and the first postoperative visit. We additionally determined whether these reasons were addressed in each patient's discharge instructions.

Results A total of 98 patients underwent eTNTS during the study period. The median length of hospital stay was 2 days (interquartile range [IQR]: 1–4 days), at which point most patients (82%) were provided with eTNTS-specific discharge instructions. First postoperative visit took place 9 days after discharge (IQR: 7–10 days). Within that time, 54% of patients made at least one phone call or sent at least electronic message and 17% presented to the ED. Most common reasons for call/message were nasal care, appointment scheduling, and symptom and medication questions.

Conclusion Through this work, we highlight the most common reasons for resource utilization via patient phone calls, messages, and ED visits among our cohort to better understand any shortfall or gap in the discharge process that may reduce these events.

Keywords

endoscopic skull base surgery - TNTS - discharge instructions - readmissions

Authors' Contributions

M. H., K. K. B., M. N. N., and N. K. performed planning, data collection, statistical analysis, interpretation of results, literature survey, writing the manuscript, and submission. M. B. W. supervised the study and supported in interpretation of results and manuscript preparation. A. P. H., W. K., J. T. L., J. D. S., and M. B. contributed to data collection and review of the manuscript.

^* These authors contributed equally to this study and share first co-authorship.

Publication History

Received: 15 January 2022

Accepted: 26 April 2022

Accepted Manuscript online:
03 May 2022

Article published online:
05 July 2022

• References

• 1 Vengerovich G, Park KW, Antoury L. et al. Readmissions after endoscopic skull base surgery: associated risk factors and prevention. Int Forum Allergy Rhinol 2020; 10 (01) 110-113
• 2 Silva NA, Taylor BES, Herendeen JS, Reddy R, Eloy JA, Liu JK. Return to the emergency room with or without readmission after endoscopic transsphenoidal surgery in socioeconomically disadvantaged patients at an urban medical center. World Neurosurg 2018; 124: e131-e138
• 3 Rizvi ZH, Ferrandino R, Luu Q, Suh JD, Wang MB. Nationwide analysis of unplanned 30-day readmissions after transsphenoidal pituitary surgery. Int Forum Allergy Rhinol 2019; 9 (03) 322-329
• 4 Barker II FG, Klibanski A, Swearingen B. Transsphenoidal surgery for pituitary tumors in the United States, 1996-2000: mortality, morbidity, and the effects of hospital and surgeon volume. J Clin Endocrinol Metab 2003; 88 (10) 4709-4719
• 5 Prete A, Corsello SM, Salvatori R. Current best practice in the management of patients after pituitary surgery. Ther Adv Endocrinol Metab 2017; 8 (03) 33-48
• 6 Cote DJ, Dasenbrock HH, Muskens IS. et al. Readmission and other adverse events after transsphenoidal surgery: prevalence, timing, and predictive factors. J Am Coll Surg 2017; 224 (05) 971-979
• 7 Bohl MA, Ahmad S, Jahnke H. et al. Delayed hyponatremia is the most common cause of 30-day unplanned readmission after transsphenoidal surgery for pituitary tumors. Neurosurgery 2016; 78 (01) 84-90
• 8 Ramaseshan AS, LaSala C, O'Sullivan DM, Steinberg AC. Patient-initiated telephone calls in the postoperative period after female pelvic reconstructive surgery. Female Pelvic Med Reconstr Surg 2020; 26 (10) 626-629
• 9 Esposito F, Dusick JR, Fatemi N, Kelly DF. Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery. Oper Neurosurg (Hagerstown) 2007;60(04, Suppl 2):295–303, discussion 303–304
• 10 Hendricks BL, Shikary TA, Zimmer LA. Causes for 30-day readmission following transsphenoidal surgery. Otolaryngol Head Neck Surg 2016; 154 (02) 359-365
• 11 Chowdhury T, Prabhakar H, Bithal PK, Schaller B, Dash HH. Immediate postoperative complications in transsphenoidal pituitary surgery: a prospective study. Saudi J Anaesth 2014; 8 (03) 335-341
• 12 Younus I, Gerges MM, Dobri GA, Ramakrishna R, Schwartz TH. Readmission after endoscopic transsphenoidal pituitary surgery: analysis of 584 consecutive cases. J Neurosurg 2019; 133 (04) 1242-1247
• 13 Horstman MJ, Mills WL, Herman LI. et al. Patient experience with discharge instructions in postdischarge recovery: a qualitative study. BMJ Open 2017; 7 (02) e014842
• 14 Jack BW, Chetty VK, Anthony D. et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med 2009; 150 (03) 178-187
• 15 Olson DP, Windish DM. Communication discrepancies between physicians and hospitalized patients. Arch Intern Med 2010; 170 (15) 1302-1307
• 16 Makaryus AN, Friedman EA. Patients' understanding of their treatment plans and diagnosis at discharge. Mayo Clin Proc 2005; 80 (08) 991-994
• 17 Coleman EA, Chugh A, Williams MV. et al. Understanding and execution of discharge instructions. Am J Med Qual 2013; 28 (05) 383-391
• 18 Lo S, Stuenkel DL, Rodriguez L. The impact of diagnosis-specific discharge instructions on patient satisfaction. J Perianesth Nurs 2009; 24 (03) 156-162
• 19 Hovsepian J, McGah C, O'Brien C. Postoperative instructions preoperatively-evaluating the effectiveness of a teaching model on patient satisfaction regarding instructions for home care. J Perianesth Nurs 2017; 32 (03) 231-237
• 20 Strong S, Bettin A. An initiative to improve patient discharge satisfaction. Rehabil Nurs 2015; 40 (01) 52-59
• 21 Baker DW, Gazmararian JA, Williams MV. et al. Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. Am J Public Health 2002; 92 (08) 1278-1283
• 22 Wilkin ZL. Effects of video discharge instructions on patient understanding: a prospective, randomized trial. Adv Emerg Nurs J 2020; 42 (01) 71-78