Factors Associated with 30-Day Readmission after Endoscopic Transsphenoidal Surgery: The Critical Role of Dedicated Endocrinology Discharge Coordination

Alex Devarajan; Ansley Unterberger; Jack Y. Zhang; Jonathan T. Dullea; Vikram Vasan; Alexander J. Schupper; Rui Feng; Eric Gong; John W. Rutland; Joshua Bederson; Raj K. Shrivastava

doi:10.1055/a-2717-2962

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

J Neurol Surg B Skull Base
DOI: 10.1055/a-2717-2962

Original Article

Factors Associated with 30-Day Readmission after Endoscopic Transsphenoidal Surgery: The Critical Role of Dedicated Endocrinology Discharge Coordination

Authors

Alex Devarajan ^‡

¹Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Ansley Unterberger^‡

¹Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Jack Y. Zhang

¹Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Jonathan T. Dullea

¹Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Vikram Vasan

¹Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Alexander J. Schupper

¹Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Rui Feng

¹Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Eric Gong

¹Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
John W. Rutland

¹Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Joshua Bederson

¹Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Raj K. Shrivastava

¹Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States

Abstract

Objectives

This study aimed to identify demographic, clinical, and operative factors of unplanned 30-day readmission following endoscopic transsphenoidal surgery (ETS).

Design

Single-center retrospective study.

Setting

A tertiary academic medical center based in New York, NY.

Participants

A total of 386 adult patients who underwent non-emergent ETS for pituitary adenomas between March 2009 and May 2020.

Main Outcome Measures

The primary outcome was 30-day unplanned hospital admission. Clinical and demographic characteristics were analyzed using χ² and Student's t-tests. For factors with p-value <0.1, multivariate logistic regression models were constructed to estimate the adjusted odds of 30-day readmission across predictive factors.

Results

Of 386 patients who received ETS, 29 (7.5%) patients required readmission within 30 days of discharge. Eleven (2.8%) patients were readmitted for complications related to electrolyte derangements (syndrome of inappropriate antidiuretic hormone, hyponatremia), followed by 5 (1.3%) patients with epistaxis. On multivariate analysis, pituitary microadenomas (p = 0.032), transient diabetes insipidus (DI; p = 0.021), and preoperative visual cranial nerve palsies (CN III/IV/VI; p = 0.019) were associated with increased odds of 30-day readmission.

Conclusion

Patients with pituitary microadenomas, transient DI, and preoperative cranial nerve palsies were at an increased risk for unplanned 30-day readmission after ETS. Dedicated neuroendocrinology involvement is necessary in the postoperative period to reduce readmission risk in these patients. Identification and careful monitoring of these at-risk populations is necessary, as targeted postdischarge care may prevent readmission and improve both patient and hospital outcomes.

Keywords

endoscopic transsphenoidal surgery - health care quality assurance - patient readmission - pituitary adenomas

Full Text

References

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