30-Day Readmissions and Coordination of Care Following Endoscopic Transsphenoidal Pituitary Surgery: Experience with 409 Patients

Michael K. Ghiam; Darius E. Chyou; Cortney L. Dable; Andrew P. Katz; Daniel G. Eichberg; Hang Zhang; Alejandro R. Ayala; Atil Y. Kargi; Ricardo J. Komotar; Zoukaa Sargi

doi:10.1055/s-0041-1729980

Journal of Neurological Surgery Part B: Skull Base, Inhaltsverzeichnis

J Neurol Surg B Skull Base 2022; 83(S 02): e410-e418
DOI: 10.1055/s-0041-1729980

Original Article

30-Day Readmissions and Coordination of Care Following Endoscopic Transsphenoidal Pituitary Surgery: Experience with 409 Patients

Michael K. Ghiam

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

,

Darius E. Chyou

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

,

Andrew P. Katz

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

,

Daniel G. Eichberg

³Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States

,

Hang Zhang

⁴Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami, Florida, United States

,

Alejandro R. Ayala

⁵Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States

,

Atil Y. Kargi

⁵Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States

,

Ricardo J. Komotar

³Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States

,

Zoukaa Sargi

⁶Department of Otolaryngology, Head and Neck Surgery, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, Florida, United States

› Institutsangaben

Abstract

Objective The study aimed to (1) quantify readmission rates and common causes of readmission following endoscopic transsphenoidal pituitary surgery (ETPS); (2) identify risk factors that may predict readmission within 30 days; (3) assess postoperative care coordination with endocrinology follow-up; and (4) identify patients for whom targeted interventions may reduce 30-day readmissions.

Methods Retrospective quality improvement review of patients with pituitary adenoma who underwent ETPS from December 2010 to 2018 at a single tertiary care center.

Results A total of 409 patients were included in the study, of which 57 (13.9%) were readmitted within 30 days. Hyponatremia was the most common cause of readmission (4.2%) followed by pain/headache (3.9%), cerebrospinal fluid leak (3.4%), epistaxis (2.7%), hypernatremia (1.2%), and adrenal insufficiency (1.2%). Patients with hyponatremia were readmitted significantly earlier than other causes (4.3 ± 2.2 vs. 10.6 ± 10.9 days from discharge, p = 0.032). Readmitted patients had significantly less frequent outpatient follow-up with an endocrinologist than the nonreadmitted cohort (56.1 vs. 70.5%, p = 0.031). Patients who had outpatient follow-up with an endocrinologist were at lower risk of readmission compared with those without (odds ratio: 0.46; 95% confidence interval: 0.24–0.88).

Conclusion Delayed hyponatremia is one of the most common causes of 30-day readmission following ETPS. Postoperative follow-up with an endocrinologist may reduce risk of 30-day readmission following ETPS.

Implications for Clinical Practice A multidisciplinary team incorporating otolaryngologist, neurosurgeons, and endocrinologist may identify patients at risk of 30-day readmissions. Protocols checking serum sodium within 1 week of surgery in conjunction with endocrinologist to tailor fluid restriction may reduce readmissions from delayed hyponatremia.

Keywords

readmissions - transsphenoidal surgery - pituitary surgery - risk factors - endocrinology - coordination of care

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Referenzen

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