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J Neurol Surg B Skull Base 2022; 83(S 02): e410-e418
DOI: 10.1055/s-0041-1729980
Original Article

30-Day Readmissions and Coordination of Care Following Endoscopic Transsphenoidal Pituitary Surgery: Experience with 409 Patients

Authors

  • Michael K. Ghiam

    1   Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, United States

  • Darius E. Chyou

    2   University of Miami Miller School of Medicine, Miami, Florida, United States

  • Cortney L. Dable

    2   University of Miami Miller School of Medicine, Miami, Florida, United States

  • Andrew P. Katz

    1   Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, United States

  • Daniel G. Eichberg

    3   Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States

  • Hang Zhang

    4   Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami, Florida, United States

  • Alejandro R. Ayala

    5   Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States

  • Atil Y. Kargi

    5   Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States

  • Ricardo J. Komotar

    3   Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States

  • Zoukaa Sargi

    6   Department of Otolaryngology, Head and Neck Surgery, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, Florida, United States

Funding None.
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Abstract

Objective The study aimed to (1) quantify readmission rates and common causes of readmission following endoscopic transsphenoidal pituitary surgery (ETPS); (2) identify risk factors that may predict readmission within 30 days; (3) assess postoperative care coordination with endocrinology follow-up; and (4) identify patients for whom targeted interventions may reduce 30-day readmissions.

Methods Retrospective quality improvement review of patients with pituitary adenoma who underwent ETPS from December 2010 to 2018 at a single tertiary care center.

Results A total of 409 patients were included in the study, of which 57 (13.9%) were readmitted within 30 days. Hyponatremia was the most common cause of readmission (4.2%) followed by pain/headache (3.9%), cerebrospinal fluid leak (3.4%), epistaxis (2.7%), hypernatremia (1.2%), and adrenal insufficiency (1.2%). Patients with hyponatremia were readmitted significantly earlier than other causes (4.3 ± 2.2 vs. 10.6 ± 10.9 days from discharge, p = 0.032). Readmitted patients had significantly less frequent outpatient follow-up with an endocrinologist than the nonreadmitted cohort (56.1 vs. 70.5%, p = 0.031). Patients who had outpatient follow-up with an endocrinologist were at lower risk of readmission compared with those without (odds ratio: 0.46; 95% confidence interval: 0.24–0.88).

Conclusion Delayed hyponatremia is one of the most common causes of 30-day readmission following ETPS. Postoperative follow-up with an endocrinologist may reduce risk of 30-day readmission following ETPS.

Implications for Clinical Practice A multidisciplinary team incorporating otolaryngologist, neurosurgeons, and endocrinologist may identify patients at risk of 30-day readmissions. Protocols checking serum sodium within 1 week of surgery in conjunction with endocrinologist to tailor fluid restriction may reduce readmissions from delayed hyponatremia.

Keywords

readmissions - transsphenoidal surgery - pituitary surgery - risk factors - endocrinology - coordination of care

Note

Interim results of this study were presented as a poster at the 2019 American Rhinologic Society Meeting in September 2019, New Orleans, LA.


Authors' Contributions

M.K.G. supported in study design, data collection, analysis, and presentation. D.E.C. and C.L.D. performed data collection, analysis, and presentation. A.P.K., D.G.E., H.Z., A.R.A., A.Y.K., and R.J.K. carried out study analysis. Z.S. contributed to study design, analysis, and presentation.


Supplementary Material



Publikationsverlauf

Eingereicht: 12. Juli 2020

Angenommen: 26. März 2021

Artikel online veröffentlicht:
25. Mai 2021

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