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Delayed Hyponatremia Is the Most Common Cause of 30-Day Unplanned Readmission After Transsphenoidal Surgery for Pituitary Tumors.
- Source :
-
Neurosurgery [Neurosurgery] 2016 Jan; Vol. 78 (1), pp. 84-90. - Publication Year :
- 2016
-
Abstract
- Background: Unplanned readmission after surgical procedures is an important quality metric. Yet, readmission rates and causes have not been evaluated for patients after transsphenoidal surgery for pituitary tumors.<br />Objective: To analyze unplanned 30-day readmissions at a pituitary center and to encourage the development of effective clinical pathways to prevent readmission.<br />Methods: A retrospective review of adult patients who underwent transsphenoidal surgery for pituitary lesions at Barrow Neurological Institute (January 2011-March 2014) was performed to identify causes of unplanned readmission within 30 days of surgery. Patient demographics, tumor details, surgical complications, and endocrine function were documented.<br />Results: Of 303 patients who had transsphenoidal surgery, 27 (8.9%) were readmitted within 30 days. Most of the 27 (15 [55.6%]) had delayed hyponatremia. Other causes were diabetes insipidus (4 [14.8%]), adrenal insufficiency (2 [7.4%]), and cerebrospinal fluid leak, epistaxis, cardiac arrhythmia, pneumonia, urinary tract infection, and hypoglycemia (1 each [3.7%]). Outpatient sodium screening was performed as needed. In cases of hyponatremia, the mean postoperative day of readmission was day 8 (range, 6-12 days) and the mean serum sodium was 119 mmol/L (range, 111-129 mmol/L). Numerous patient and surgical factors were examined, and no specific predictors of readmission were identified. We developed an outpatient care pathway for managing hyponatremia with the goal of improving readmission rates.<br />Conclusion: This study establishes a quality benchmark for readmission rates after transsphenoidal surgery for pituitary lesions and identifies delayed hyponatremia as the primary cause. Implementation of an outpatient care pathway for managing hyponatremia may improve readmission rates.
- Subjects :
- Adenoma diagnosis
Adenoma epidemiology
Adult
Aged
Cerebrospinal Fluid Leak diagnosis
Cerebrospinal Fluid Leak epidemiology
Female
Humans
Hyponatremia epidemiology
Male
Middle Aged
Pituitary Neoplasms diagnosis
Pituitary Neoplasms epidemiology
Postoperative Complications epidemiology
Prospective Studies
Retrospective Studies
Risk Factors
Time Factors
Adenoma surgery
Hyponatremia diagnosis
Patient Readmission trends
Pituitary Neoplasms surgery
Postoperative Complications diagnosis
Sphenoid Sinus surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4040
- Volume :
- 78
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Neurosurgery
- Publication Type :
- Academic Journal
- Accession number :
- 26348011
- Full Text :
- https://doi.org/10.1227/NEU.0000000000001003