Bohl Michael A, Ahmad Shah, Jahnke Heidi, Shepherd Deborah, Knecht Laura, White William L, Little Andrew S
*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.
Neurosurgery. 2016 Jan;78(1):84-90. doi: 10.1227/NEU.0000000000001003.
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.
To analyze unplanned 30-day readmissions at a pituitary center and to encourage the development of effective clinical pathways to prevent readmission.
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.
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.
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.
外科手术后的非计划再入院是一项重要的质量指标。然而，垂体瘤经蝶窦手术后患者的再入院率及原因尚未得到评估。
分析垂体疾病治疗中心30天内的非计划再入院情况，并推动制定有效的临床路径以预防再入院。
对在巴罗神经学研究所（2011年1月至2014年3月）接受垂体病变经蝶窦手术的成年患者进行回顾性研究，以确定术后30天内非计划再入院的原因。记录患者人口统计学资料、肿瘤详情、手术并发症及内分泌功能。
303例行经蝶窦手术的患者中，27例（8.9%）在30天内再次入院。这27例患者中，大多数（15例[55.6%]）发生了迟发性低钠血症。其他原因包括尿崩症（4例[14.8%]）、肾上腺功能不全（2例[7.4%]）以及脑脊液漏、鼻出血、心律失常、肺炎、尿路感染和低血糖（各1例[3.7%]）。根据需要进行门诊血钠筛查。发生低钠血症的患者，再次入院的平均术后天数为第8天（范围6 - 12天），平均血清钠为119 mmol/L（范围111 - 129 mmol/L）。研究了众多患者和手术因素，未发现再入院的特定预测因素。我们制定了一个管理低钠血症的门诊护理路径，目标是提高再入院率。
本研究确立了垂体病变经蝶窦手术后再入院率的质量基准，并确定迟发性低钠血症是主要原因。实施管理低钠血症的门诊护理路径可能会提高再入院率。
