title: Incidence and Risk Factors for Prolonged Hospitalization and Readmission after Transsphenoidal Pituitary Surgery.
abstract: To evaluate the incidence and factors associated with 30-day readmission and to analyze risk factors for prolonged hospital length of stay following transsphenoidal pituitary surgery.
  
  
  
  Retrospective longitudinal claims analysis.
  
  
  
  American College of Surgeons National Surgical Quality Improvement Program.
  
  
  
  The database of the American College of Surgeons National Surgical Quality Improvement Program was queried for patients who underwent transsphenoidal pituitary surgery (Current Procedural Terminology code 61548 or 62165) between 2005 and 2014. Patient demographic information, indications for surgery, and incidence of hospital readmission and length of stay were reviewed. Risk factors for readmission and prolonged length of stay, defined as >75th percentile for the cohort, were identified through logistic regression modeling.
  
  
  
  A total of 1006 patients were included for analysis. Mean hospital length of stay after surgery was 4.1 ± 0.2 days. Predictors of prolonged length of stay were operative time (P < .001, odds ratio [OR] = 1.7, 95% confidence interval [95% CI] = 1.5-2.0), bleeding disorder (P = .049, OR = 3.1, 95% CI = 1.0-9.5), insulin-dependent diabetes (P = .007, OR = 2.4, 95% CI = 1.3-4.4), and reoperation (P < .001, OR = 10.3, 95% CI = 4.7-23.9). In a subset analysis of 529 patients who had surgery between 2012 and 2014, 7.2% (n = 38) required hospital readmission. History of congestive heart failure (CHF) was a predictor of hospital readmission (P = 0.03, OR = 12.7, 95% CI = 1.1-144.0).
  
  
  
  This review of a large validated surgical database demonstrates that CHF is an independent predictor of hospital readmission after transsphenoidal surgery. Although CHF is a known risk factor for postoperative complications, it poses unique challenges to patients with potential postoperative pituitary dysfunction.
authors.affiliation: Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA andres.bur@uphs.upenn.edu.
authors.forename: Andrés M
authors.initials: AM
authors.lastname: Bur
authors.affiliation: Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Brant
authors.affiliation: Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newman
authors.affiliation: Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Kyle M
authors.initials: KM
authors.lastname: Hatten
authors.affiliation: Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Cannady
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.affiliation: Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: John Y K
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Nithin D
authors.initials: ND
authors.lastname: Adappa
mesh_terms: D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010900:Pituitary Diseases / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States
keywords: National Surgical Quality Improvement Program; length of stay; pituitary surgery; readmission; transsphenoidal