Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
J Clin Endocrinol Metab. 2023 Jul 14;108(8):e623-e633. doi: 10.1210/clinem/dgad066.
Postoperative hyponatremia leads to prolonged hospital length of stay and readmission within 30 days.
To assess 3 strategies for reducing rates of postoperative hyponatremia and analyze risk factors for hyponatremia.
Two retrospective analyses and 1 prospective study.
Tertiary referral hospital.
Patients undergoing transsphenoidal surgery for pituitary adenomas and other sellar and parasellar pathologies.
INTERVENTION(S): Phase 1: no intervention. Phase 2: postoperative day (POD) 7 sodium testing and patient education. Phase 3: fluid restriction to 1 L/day on discharge in addition to phase 2 interventions.
Rates of early and delayed hyponatremia and readmissions. Secondary outcomes were risk factors for hyponatremia and readmission costs.
In phase 1, 296 patients underwent transsphenoidal surgery. Twenty percent developed early and 28% delayed hyponatremia. Thirty-eight percent underwent POD 7 sodium testing. Readmission rates were 15% overall and 4.3% for hyponatremia. In phase 2 (n = 316), 22% developed early and 25% delayed hyponatremia. Eighty-nine percent complied with POD 7 sodium testing. Readmissions were unchanged although severity of hyponatremia was reduced by 60%. In phase 3 (n = 110), delayed hyponatremia was reduced 2-fold [12.7%, relative risk (RR) = 0.52] and readmissions 3-fold [4.6%, RR = 0.30 (0.12-0.73)]; readmissions for hyponatremia were markedly reduced. Hyponatremia readmission increased costs by 30%.
Restricting fluid to 1 L/day on discharge decreases rates of delayed hyponatremia and readmissions by 50%. Standardized patient education and POD 7 sodium testing decreases severity of hyponatremia but does not impact readmission rates. These protocols should be considered standard practice for patients undergoing transsphenoidal surgery.
术后低钠血症会导致住院时间延长和术后 30 天内再次入院。
评估减少术后低钠血症发生率的 3 种策略，并分析低钠血症的危险因素。
两项回顾性分析和一项前瞻性研究。
三级转诊医院。
接受经蝶窦手术治疗垂体腺瘤和其他鞍区及鞍旁病变的患者。
第 1 阶段：无干预。第 2 阶段：术后第 7 天进行钠检测和患者教育。第 3 阶段：除第 2 阶段干预措施外，出院时将液体限制在 1 L/天。
早期和迟发性低钠血症以及再入院率。次要结局为低钠血症和再入院费用的危险因素。
第 1 阶段，296 例患者接受了经蝶窦手术。20%的患者发生早期和 28%的患者发生迟发性低钠血症。38%的患者进行了术后第 7 天的钠检测。总再入院率为 15%，低钠血症再入院率为 4.3%。第 2 阶段（n=316），22%的患者发生早期和 25%的患者发生迟发性低钠血症。89%的患者接受了术后第 7 天的钠检测。尽管低钠血症的严重程度降低了 60%，但再入院率没有变化。第 3 阶段（n=110），迟发性低钠血症减少了 2 倍[12.7%，相对风险（RR）=0.52]，再入院率减少了 3 倍[4.6%，RR=0.30（0.12-0.73）]；低钠血症的再入院率明显降低。低钠血症再入院使成本增加了 30%。
出院时将液体限制在 1 L/天可将迟发性低钠血症和再入院率降低 50%。标准化的患者教育和术后第 7 天的钠检测可降低低钠血症的严重程度，但不会影响再入院率。这些方案应被视为接受经蝶窦手术治疗的患者的标准治疗方法。
