Hendricks Brian L, Shikary Tasneem A, Zimmer Lee A
Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA.
Otolaryngol Head Neck Surg. 2016 Feb;154(2):359-65. doi: 10.1177/0194599815617130. Epub 2015 Nov 17.
The Affordable Care Act Readmissions Reduction Program introduced reimbursement policy changes resulting in penalties for hospitals with higher-than-average readmission rates among several categories, including elective surgical cases. We examined the rate of complications resulting in 30-day readmission following endoscopic transsphenoidal surgery.
Case series with chart review.
Academic tertiary care center.
A database of 466 consecutive patients who underwent endoscopic transsphenoidal surgery at a tertiary care center between April 2006 and July 2014 was reviewed for 30-day causes for readmission, length of stay, level of care required, and average cost.
Twenty-nine readmissions were identified within our study period, indicating a 30-day readmission rate of 6.2%. Among all patients, rates of 30-day readmission were 2.1% for epistaxis, 1.5% for hyponatremia, 0.9% for cerebrospinal fluid leak, and 1.7% for other medical conditions. Average cost per readmission ranged from $6011 for hyponatremia to $24,613 for cerebrospinal fluid leak.
Overall, the rate of 30-day readmission following endoscopic pituitary surgery is low. However, common causes of readmission do add significant cost to the overall care of this patient population. Special attention to surgical technique to prevent epistaxis and cerebrospinal fluid rhinorrhea, as well as multidisciplinary team management to avoid postoperative endocrine dysfunction, is critical to minimize these complications.
《平价医疗法案再入院减少计划》引入了报销政策变化，对包括择期手术病例在内的几类再入院率高于平均水平的医院进行处罚。我们研究了内镜经蝶窦手术后导致30天再入院的并发症发生率。
病例系列研究并进行病历审查。
学术性三级医疗中心。
回顾了2006年4月至2014年7月在一家三级医疗中心连续接受内镜经蝶窦手术的466例患者的数据库，以了解30天再入院原因、住院时间、所需护理级别和平均费用。
在我们的研究期间共确定了29例再入院病例，30天再入院率为6.2%。在所有患者中，鼻出血导致的30天再入院率为2.1%，低钠血症为1.5%，脑脊液漏为0.9%，其他医疗状况为1.7%。每次再入院的平均费用从低钠血症的6011美元到脑脊液漏的24613美元不等。
总体而言，内镜垂体手术后30天再入院率较低。然而，再入院的常见原因确实给这一患者群体的整体护理增加了显著成本。特别关注手术技术以预防鼻出血和脑脊液鼻漏，以及多学科团队管理以避免术后内分泌功能障碍，对于将这些并发症降至最低至关重要。
