title: Readmission and Other Adverse Events after Transsphenoidal Surgery: Prevalence, Timing, and Predictive Factors.
abstract: BACKGROUND
  Transsphenoidal surgery is a common neurosurgical procedure for accessing the pituitary and anterior skull base, yet few multicenter analyses have evaluated outcomes after this procedure.
  
  
  METHODS
  Patients undergoing transsphenoidal surgery from 2006 to 2015 were extracted from the American College of Surgeons NSQIP database. Logistic regression was used to identify predictors of 30-day complications.
  
  
  RESULTS
  Of 1,240 patients included in this analysis, 6.9% experienced a major complication, and 9.4% experienced any complication within 30 days. Other adverse events included death in 0.7% and nonroutine hospital discharge in 5.3%. Most adverse events occurred within the first 2 weeks postoperatively; 82.9% of patients experienced their first complication during the initial hospital stay. Multivariable analysis demonstrated that predictors of hospital stay longer than 4 days included American Society of Anesthesiologists classification III to V (p = 0.015), insulin-dependent diabetes mellitus (p < 0.001), and operative time in the third and fourth quartiles (both p < 0.001). American Society of Anesthesiologists classification III to V and operative time in the fourth quartile were also predictors of any adverse event (p = 0.01 and p = 0.005, respectively). Among these patients, 3.7% underwent reoperation, the most common reason for which was postoperative cerebrospinal fluid leak (63.6%). Readmission occurred after 8.5% of cases at a median of 11.0 days post-discharge. The most common cause of readmission was hyponatremia (29.5%), followed by delayed postoperative cerebrospinal fluid leak (16.0%).
  
  
  CONCLUSIONS
  Overall rates of adverse events in patients undergoing transsphenoidal surgery are relatively low, and most occur before discharge from the hospital. Post-discharge complications associated with transsphenoidal surgery include deep vein thrombosis, pulmonary embolism, and urinary tract infection. Delayed postoperative cerebrospinal fluid leak is the major cause of reoperation, and hyponatremia is the major cause of readmission.
authors.affiliation: Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA Department of Neurosurgery, University Medical Center, Utrecht, The Netherlands.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cote
authors.forename: Hormuz H
authors.initials: HH
authors.lastname: Dasenbrock
authors.forename: Ivo S
authors.initials: IS
authors.lastname: Muskens
authors.forename: Marike L D
authors.initials: MLD
authors.lastname: Broekman
authors.forename: Hasan A
authors.initials: HA
authors.lastname: Zaidi
authors.forename: Ian F
authors.initials: IF
authors.lastname: Dunn
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Smith
authors.forename: Edward R
authors.initials: ER
authors.lastname: Laws
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D058996:Quality Improvement; D012086:Reoperation; D012307:Risk Factors; D013100:Sphenoid Bone / Q000601:surgery*; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult