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J Neurol Surg B Skull Base
DOI: 10.1055/a-2765-5514
Original Article

Key Causes and Temporal Window of Unplanned Readmissions Following Transsphenoidal Pituitary Surgery: A Systematic Review and Meta-analysis

Authors

  • Jiajun Chen  ‡   ‡

    1   Department of Nursing, Huashan Hospital, Fudan University, Shanghai, China

  • Yingyue Zhang‡   ‡

    1   Department of Nursing, Huashan Hospital, Fudan University, Shanghai, China

  • Mengqiang Luo‡   ‡

    2   Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China

  • Ying Huang‡   ‡

    1   Department of Nursing, Huashan Hospital, Fudan University, Shanghai, China

  • Xuehua Che

    2   Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China

Funding Information This work was supported by Shanghai Zhou Liangfu Medical Development Foundation (SM00036-2022-1).
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Abstract

Objective

Unplanned readmission (UR) after transsphenoidal pituitary surgery poses a significant healthcare burden, but its exact incidence, causes, and risk factors remain unclear. This meta-analysis aims to estimate the 30-day UR rate, identify its main causes, and explore associated risk factors.

Methods

A systematic search of PubMed, Embase, Scopus, and Web of Science was conducted from inception to July 2025. Included studies reported 30-day UR rates and risk factors after transsphenoidal pituitary adenoma resection. Pooled incidence rates and odds ratios (ORs) with 95% confidence intervals (CIs) were derived using random-effects models. Heterogeneity was evaluated with I2 statistics, and study quality was assessed using the Newcastle-Ottawa scale.

Results

A total of 10 studies with 51,618 patients were included. The pooled 30-day UR rate was 9.68% (95% CI: 7.87–11.91). Hyponatremia (28.67%, 95% CI: 15.30–53.72) and cerebrospinal fluid leak (15.7%, 95% CI: 8.07–30.53) were the most common causes. Both all-cause and hyponatremia-related readmissions clustered early after surgery, with mean times of 9.96 days (95% CI: 6.51–13.42) and 8.05 days (95% CI: 5.86–10.25), respectively, suggesting a shared high-risk window around the first 2 weeks. No risk factor was reported in more than two studies, preventing meta-analysis of predictors.

Conclusion

This meta-analysis confirms a high 30-day UR rate (nearly 10%) after transsphenoidal pituitary surgery, primarily due to hyponatremia and CSF leak. The aligned timing of readmissions underscores a critical post-discharge period. These findings emphasize the need for structured follow-up and early intervention—especially extended electrolyte monitoring and complication-specific management—to effectively reduce readmission risk.

Keywords

pituitary adenoma - transsphenoidal surgery - unplanned readmission - meta-analysis - hyponatremia - cerebrospinal fluid leak - risk factors

Data Availability Statement

The data that support the findings of this meta-analysis are available from the corresponding authors upon reasonable request. All data extracted from included studies are presented within the manuscript and its supplementary materials.


Informed Consent

This study is a meta-analysis based on previously published studies and does not involve direct contact with human or animal subjects.


‡ These authors contributed equally to this work.


Supplementary Material



Publication History

Received: 22 September 2025

Accepted: 04 December 2025

Accepted Manuscript online:
08 December 2025

Article published online:
18 December 2025

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