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J Neurol Surg B Skull Base
DOI: 10.1055/s-0044-1789193
Original Article

A Multicenter Study of Unplanned Hospital Readmissions after Transsphenoidal Surgery for Cushing's Disease

Mark A. Pacult
1   Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
,
Michael Karsy
2   Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
,
James J. Evans
3   Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
,
Won Kim
4   Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States
,
Donato R. Pacione
5   Department of Neurosurgery, New York University, New York, New York, United States
,
Paul A. Gardner
6   Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Juan C. Fernandez-Miranda
7   Department of Neurosurgery, Stanford University, Palo Alto, California, United States
,
Gabriel Zada
8   Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Robert C. Rennert
9   Department of Neurosurgery, University of Utah, Salt Lake City, Utah, United States
,
Julie M. Silverstein
10   Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, United States
11   Division of Endocrinology, Metabolism, and Lipid Research, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States
,
Albert H. Kim
10   Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, United States
,
Varun R. Kshettry 
12   Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, United States
,
Michael R. Chicoine
13   Department of Neurosurgery, University of Missouri, Columbia, Missouri, United States
,
Andrew S. Little
1   Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States
› Author Affiliations Funding The authors acknowledge the Barrow Neurological Foundation, the Lodestar Foundation, Corcept, The Foundation for Barnes-Jewish Hospital, and grateful patients for supporting this work.
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Abstract

Objectives Patients undergoing surgery for Cushing's disease may be more likely to be readmitted to the hospital than other patients with pituitary disorders. We investigated rates, causes, and predictors of unplanned readmission following transsphenoidal surgery for Cushing's disease to identify areas for clinical, financial, and administrative improvements.

Design Retrospective cohort study.

Setting Academic pituitary centers in the United States participating in a multicenter surgical outcome registry.

Participants Five hundred and nineteen patients underwent transsphenoidal surgery for treatment of Cushing's disease by 26 surgeons at nine participating institutions from 2003 to 2023.

Main Outcome Measures Unplanned 90-day readmission rates and causes of readmission.

Results Unplanned readmissions occurred in 57/519 patients (11.0%), with hyponatremia in 12/57 (21%), cerebrospinal fluid leak evaluation in 8/57 (14%), epistaxis in 6/57 (10%), deep vein thrombosis in 4/57 (7%), syncope in 3/57 (5%), and headache in 3/57 (5%). Factors including no tumor on initial magnetic resonance imaging, return to the operating room during the index admission, lack of early remission, and inpatient complications were associated with a greater probability of readmission on univariate analysis. However, none remained predictive on multivariate analysis.

Conclusion Our results show that readmission rates after transsphenoidal surgery for Cushing's disease are comparable to previously reported rates for all pituitary-related disorders, with the most common reason being hyponatremia. High-impact clinical protocols focused on preventing delayed hyponatremia may reduce the risk of readmission. Failure to identify significant predictors of readmission, even in this large clinical dataset, underscores the challenge of identifying high-risk clinical cohorts.

Keywords

body mass index - Cushing's disease - deep venous thrombosis - dyslipidemia - hyperglycemia - hyponatremia - pituitary

Previous Presentation

This work was presented at the North American Skull Base Society meeting in Atlanta, Georgia, February 16–19, 2024.




Publication History

Received: 21 February 2024

Accepted: 29 July 2024

Article published online:
20 August 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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