Michael A Bohl1, Shah Ahmad, Heidi Jahnke, Deborah Shepherd, Laura Knecht, William L White, Andrew S Little. 1. *Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona;‡University of Arizona College of Medicine-Phoenix, Phoenix, Arizona;§Department of Internal Medicine, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Abstract
BACKGROUND: Unplanned readmission after surgical procedures is an important quality metric. Yet, readmission rates and causes have not been evaluated for patients after transsphenoidal surgery for pituitary tumors. OBJECTIVE: To analyze unplanned 30-day readmissions at a pituitary center and to encourage the development of effective clinical pathways to prevent readmission. METHODS: A retrospective review of adult patients who underwent transsphenoidal surgery for pituitary lesions at Barrow Neurological Institute (January 2011-March 2014) was performed to identify causes of unplanned readmission within 30 days of surgery. Patient demographics, tumor details, surgical complications, and endocrine function were documented. RESULTS: Of 303 patients who had transsphenoidal surgery, 27 (8.9%) were readmitted within 30 days. Most of the 27 (15 [55.6%]) had delayed hyponatremia. Other causes were diabetes insipidus (4 [14.8%]), adrenal insufficiency (2 [7.4%]), and cerebrospinal fluid leak, epistaxis, cardiac arrhythmia, pneumonia, urinary tract infection, and hypoglycemia (1 each [3.7%]). Outpatient sodium screening was performed as needed. In cases of hyponatremia, the mean postoperative day of readmission was day 8 (range, 6-12 days) and the mean serum sodium was 119 mmol/L (range, 111-129 mmol/L). Numerous patient and surgical factors were examined, and no specific predictors of readmission were identified. We developed an outpatient care pathway for managing hyponatremia with the goal of improving readmission rates. CONCLUSION: This study establishes a quality benchmark for readmission rates after transsphenoidal surgery for pituitary lesions and identifies delayed hyponatremia as the primary cause. Implementation of an outpatient care pathway for managing hyponatremia may improve readmission rates.
BACKGROUND: Unplanned readmission after surgical procedures is an important quality metric. Yet, readmission rates and causes have not been evaluated for patients after transsphenoidal surgery for pituitary tumors. OBJECTIVE: To analyze unplanned 30-day readmissions at a pituitary center and to encourage the development of effective clinical pathways to prevent readmission. METHODS: A retrospective review of adult patients who underwent transsphenoidal surgery for pituitary lesions at Barrow Neurological Institute (January 2011-March 2014) was performed to identify causes of unplanned readmission within 30 days of surgery. Patient demographics, tumor details, surgical complications, and endocrine function were documented. RESULTS: Of 303 patients who had transsphenoidal surgery, 27 (8.9%) were readmitted within 30 days. Most of the 27 (15 [55.6%]) had delayed hyponatremia. Other causes were diabetes insipidus (4 [14.8%]), adrenal insufficiency (2 [7.4%]), and cerebrospinal fluid leak, epistaxis, cardiac arrhythmia, pneumonia, urinary tract infection, and hypoglycemia (1 each [3.7%]). Outpatientsodium screening was performed as needed. In cases of hyponatremia, the mean postoperative day of readmission was day 8 (range, 6-12 days) and the mean serum sodium was 119 mmol/L (range, 111-129 mmol/L). Numerous patient and surgical factors were examined, and no specific predictors of readmission were identified. We developed an outpatient care pathway for managing hyponatremia with the goal of improving readmission rates. CONCLUSION: This study establishes a quality benchmark for readmission rates after transsphenoidal surgery for pituitary lesions and identifies delayed hyponatremia as the primary cause. Implementation of an outpatient care pathway for managing hyponatremia may improve readmission rates.
Authors: Elena L Sorba; Victor E Staartjes; Stefanos Voglis; Lazar Tosic; Giovanna Brandi; Oliver Tschopp; Carlo Serra; Luca Regli Journal: Neurosurg Rev Date: 2020-06-24 Impact factor: 3.042
Authors: Andrea Giustina; Garni Barkhoudarian; Albert Beckers; Anat Ben-Shlomo; Nienke Biermasz; Beverly Biller; Cesar Boguszewski; Marek Bolanowski; Jens Bollerslev; Vivien Bonert; Marcello D Bronstein; Michael Buchfelder; Felipe Casanueva; Philippe Chanson; David Clemmons; Maria Fleseriu; Anna Maria Formenti; Pamela Freda; Monica Gadelha; Eliza Geer; Mark Gurnell; Anthony P Heaney; Ken K Y Ho; Adriana G Ioachimescu; Steven Lamberts; Edward Laws; Marco Losa; Pietro Maffei; Adam Mamelak; Moises Mercado; Mark Molitch; Pietro Mortini; Alberto M Pereira; Stephan Petersenn; Kalmon Post; Manuel Puig-Domingo; Roberto Salvatori; Susan L Samson; Ilan Shimon; Christian Strasburger; Brooke Swearingen; Peter Trainer; Mary L Vance; John Wass; Margaret E Wierman; Kevin C J Yuen; Maria Chiara Zatelli; Shlomo Melmed Journal: Rev Endocr Metab Disord Date: 2020-09-10 Impact factor: 6.514
Authors: Abdulrazag M Ajlan; Sarah Bin Abdulqader; Achal S Achrol; Yousef Aljamaan; Abdullah H Feroze; Laurence Katznelson; Griffith R Harsh Journal: J Neurol Surg B Skull Base Date: 2017-08-03