Abstract
Introduction:
As health care payments transition from being transaction based to being value based, there will be increasing emphasis on unplanned hospital readmissions. Despite the widespread adoption of fully endoscopic transsphenoidal pituitary surgery, no studies have compared unplanned readmission rates in patients who have undergone transsphenoidal surgery using this technique to patients who have undergone surgery using the traditional microscopic technique. In this study, we present the first analysis of 30-day unplanned readmissions by transsphenoidal surgical technique.
Methods:
A total of 303 consecutive adult patients with pituitary adenomas who underwent transsphenoidal surgery between October 2011 and April 2014 at a pituitary center were retrospectively reviewed. One surgeon practiced exclusively microscopic surgery and one surgeon practiced exclusively fully endoscopic surgery. All instances and causes of unplanned readmission with 30 days of surgery were documented. Standard statistical methods were used to examine differences in the surgical cohorts and compare readmission rates.
Results:
A total of 303 patients underwent transsphenoidal surgery for pituitary adenomas (190 microscopic and 113 endoscopic). The groups were well matched with respect to demographic and tumor characteristics. The most common tumor type was nonfunctioning pituitary adenoma in both the groups. Overall, 15 (7.8%) patients who underwent microscopic surgery and 11 (9.7%) patients who underwent endoscopic surgery were readmitted within 30 days of surgery (
p
= 0.44). The most common reason for unplanned readmission in both the groups was hyponatremia secondary to syndrome of inappropriate antidiuretic hormone (10 microscopic and 5 endoscopic). One patient was readmitted for CSF leak in the endoscopic group and none in the microscopic group.
Conclusion:
There was no significance difference in unplanned readmission rate in patients who had undergone fully endoscopic transsphenoidal surgery compared with those who had undergone microscopic transsphenoidal surgery. The most common cause of readmission in both the groups was hyponatremia. Strategies aimed at identifying and managing patients with hyponatremia as an outpatient may limit readmissions. This is the first study to examine unplanned readmission following pituitary surgery.