Factors Associated with 30-Day Readmission After Endoscopic Transsphenoidal Surgery: The Critical Role of a Dedicated Inpatient Endocrinology Service

Background: Endoscopic transsphenoidal surgery (ETS) is the predominant approach to resect sellar and parasellar skull base lesions such as pituitary tumors. Given its minimally invasive nature, ETS is often preferred over transcranial approaches due to its favorable postoperative course. In high-volume pituitary surgery centers, at-risk populations for unplanned readmission may necessitate greater resource allocation and careful multidisciplinary coordination prior to discharge. We aimed to characterize this at-risk population and review the impact of a dedicated multidisciplinary pituitary team on patient outcomes.

Methods: A single-center retrospective review identified all adult patients who received nonemergent ETS for management of sellar lesions from March 2009 to May 2020. Readmission reasons were recorded. Clinical and demographic characteristics were analyzed using χ2- and student 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 patients required an unplanned readmission within 30 days of discharge. Eleven patients were readmitted for complications related to electrolyte derangements (SIADH, hyponatremia), followed by five patients with epistaxis. One patient was readmitted for management of a postoperative cerebrospinal fluid (CSF) leak. On multivariate analysis, pituitary microadenomas (p = 0.032), transient diabetes insipidus (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 diabetes insipidus, and preoperative cranial nerve palsies were at an increased risk for unplanned 30-day readmission after ETS. Low rates of readmission secondary to postoperative CSF leak were suggestive of the merits of close otolaryngology follow-up. Dedicated neuro-endocrinology 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 post-discharge care may prevent readmission and improve both patient and hospital outcomes.

Publication History

Article published online:
07 February 2025