Multidisciplinary Postoperative Care Pathway to Reduce Readmissions following Endoscopic Transsphenoidal Pituitary Surgery: Improving Quality of Patient Care

Michael K. Ghiam; Ibrahim A. Ali; Cortney L. Dable; Alejandro R. Ayala; Atil Y. Kargi; Ricardo J. Komotar; Corinna G. Levine; Zoukaa Sargi

doi:10.1055/a-1920-0758

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2022; 83(06): 626-634
DOI: 10.1055/a-1920-0758

Review Article

Multidisciplinary Postoperative Care Pathway to Reduce Readmissions following Endoscopic Transsphenoidal Pituitary Surgery: Improving Quality of Patient Care

Michael K. Ghiam

¹Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, United States

,

Ibrahim A. Ali

²University of Miami Miller School of Medicine, Miami, Florida, United States

,

Cortney L. Dable

²University of Miami Miller School of Medicine, Miami, Florida, United States

,

Alejandro R. Ayala

³Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States

,

Atil Y. Kargi

³Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States

,

Ricardo J. Komotar

⁴Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States

,

Corinna G. Levine

¹Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, United States

,

Zoukaa Sargi

¹Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, United States

› Author Affiliations

Abstract

Background Thirty-day unplanned readmission following endoscopic transsphenoidal pituitary surgery (ETPS) occurs in up to 14% of patients. Delayed hyponatremia is one of the most common causes, accounting for 30% of readmissions and often occurs within 1 week of surgery. The authors' prior retrospective review identified endocrinology follow-up as protective factor.

Objectives Implementation of a multidisciplinary postoperative care (POC) pathway: (1) to reduce 30-day hospital readmissions following ETPS and (2) improve inpatient and outpatient coordination of care with endocrinologist.

Methods This study is a single institution temporal cohort study of patients prior to (control cohort) and after implementation of the POC pathway (intervention cohort). The POC pathway utilized postdischarge 1 to 1.5 L/d fluid restriction, postoperative days 5 to 7 serum sodium, and endocrinology follow-up within 1 week of discharge to stratify patients into tiered hyponatremia regimens.

Results A total of 542 patients were included in the study, 409 (75%) in the control cohort and 133 (25%) in the intervention cohort. All-cause readmission was significantly reduced following implementation of the POC pathway (14 vs. 6%, p = 0.015). Coordination with endocrinologist significantly increased in the inpatient (96 vs. 83%, p < 0.001) and outpatient (77 vs. 68%, p = 0.042) settings. Patients who were not in the POC pathway had the highest risk of readmission (odds ratio: 2.5; 95% confidence interval: 1.1–5.5).

Conclusion A multidisciplinary POC pathway incorporating endocrinologist in conjunction with postdischarge weight-based fluid restriction and postoperative serum sodium levels can safely be used to reduce 30-day readmissions following ETPS.

Keywords

quality improvement - postoperative care pathway - readmissions - transsphenoidal pituitary surgery - pituitary surgery - risk factors - endocrinology - coordination of care

Full Text

References

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