Delayed Hyponatremia Is the Most Common Cause of 30-Day Unplanned Readmission After Transsphenoidal Surgery for Pituitary Tumors.
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.


OBJECTIVE
To analyze unplanned 30-day readmissions at a pituitary center and to encourage the development of effective clinical pathways to prevent readmission.


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.


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.


CONCLUSIONS
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.
*Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona;‡University of Arizona College of Medicine-Phoenix, Phoenix, Arizona;§Department of Internal Medicine, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Michael A
MA
Bohl
Shah
S
Ahmad
Heidi
H
Jahnke
Deborah
D
Shepherd
Laura
L
Knecht
William L
WL
White
Andrew S
AS
Little
D000236:Adenoma / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D000328:Adult; D000368:Aged; D065634:Cerebrospinal Fluid Leak / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends*; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013101:Sphenoid Sinus / Q000601:surgery*; D013997:Time Factors