PNA Medical Corner: Readmission After Pituitary Surgery
A study co-authored by several members of the PNA (Dr. Theodore Schwartz, Dr. Georgiana Dobri, and Dr. Rohan Ramakrishna) looks at readmissions after endoscopic transsphenoidal pituitary surgery. It found that 4.6% of patients in the 584 cases studied were readmitted, with hypernatremia being the most common cause.
J Neurosurg. 2019 Sep 27:1-6. doi: 10.3171/2019.7.JNS191558. [Epub ahead of print]
Readmission after endoscopic transsphenoidal pituitary surgery: analysis of 584 consecutive cases.
Younus I1, Gerges MM2,3, Dobri GA2,4,5, Ramakrishna R2, Schwartz TH2,6,4.
1 Weill Cornell Medical College, New York.
2 Departments of Neurosurgery.
3 Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
4 Neuroscience, and.
5 Endocrinology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York; and.
Hospital readmission is a key component in value-based healthcare models but there are limited data about the 30-day readmission rate after endonasal endoscopic transsphenoidal surgery (EETS) for pituitary adenoma. The objective of this study was to determine the incidence and identify factors associated with 30-day readmission after EETS for pituitary adenoma.
The authors analyzed a prospectively acquired database of patients who underwent EETS for pituitary adenoma from 2005 to 2018 at New York-Presbyterian Hospital, Weill Cornell Medicine. Clinical, socioeconomic, and radiographic data were reviewed for cases of unplanned readmission within 30 days of surgery and, as a control group, for all other patients in the series who were not readmitted. Statistical significance was determined with an alpha < 0.05 using Pearson's chi-square and Fisher's exact tests for categorical variables and the independent-samples t-test for continuous variables.
Of 584 patients undergoing EETS for pituitary adenoma, 27 (4.6%) had unplanned readmission within 30 days. Most readmissions occurred within the first week after surgery, with a mean time to readmission of 6.6 ± 3.9 days. The majority of readmissions (59%) were for hyponatremia. These patients had a mean sodium level of 120.6 ± 4.6 mEq/L at presentation. Other causes of readmission were epistaxis (11%), spinal headache (11%), sellar hematoma (7.4%), CSF leak (3.7%), nonspecific headache (3.7%), and pulmonary embolism (3.7%). The postoperative length of stay was significantly shorter for patients who were readmitted than for the controls (2.7 ± 1.0 days vs 3.9 ± 3.2 days; p < 0.05). Patients readmitted for hyponatremia had an initial length of stay of 2.6 ± 0.9 days, the shortest of any cause for readmission. The mean BMI was significantly lower for readmitted patients than for the controls (26.4 ± 3.9 kg/m2 vs 29.3 ± 6.1 kg/m2; p < 0.05).
Readmission after EETS for pituitary adenoma is a relatively rare phenomenon, with delayed hyponatremia being the primary cause. The study results demonstrate that shorter postoperative length of stay and lower BMI were associated with 30-day readmission.
DVT = deep venous thrombosis; EETS = endonasal endoscopic transsphenoidal surgery; GTR = gross-total resection; POD = postoperative day; SIADH = syndrome of inappropriate antidiuretic hormone; endonasal; endoscopic; pituitary adenoma; pituitary surgery; readmission; transsphenoidal