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National trends in hospital readmission following transsphenoidal surgery for pituitary lesions

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Abstract

Purpose

Several institutions recently published their experiences with unplanned readmissions rates after transsphenoidal surgery for pituitary lesions. Readmission rates on a national level, however, have not been explored in depth. We investigated nationwide trends in this procedure and associated independent predictors, costs, and causes of 30-day readmission.

Methods

The Nationwide Readmissions Database was queried to identify patients 18 and older who underwent transsphenoidal surgery for pituitary lesion resection (2010–2015). National trends and statistical variances were calculated based on weighted, clustered, and stratified sample means.

Results

Of the weighted total of 44,759 patients treated over the 6-year period, 4658 (10.4%) were readmitted within 30 days. Readmission rates did not change across the survey period (P = 0.71). Patients readmitted had a higher prevalence of comorbidities than those not readmitted (82.5% vs. 78.4%, respectively, P < 0.001), experienced more postoperative complications (47.2% vs. 31.8%, P < 0.001), and had a longer length of stay (6.59 vs. 4.23 days, P < 0.001) during index admission. The most common causes for readmission were SIADH (17.5%) and other hyponatremia (16.4%). Average total readmission cost was $12,080 with no significant trend across the study period (P = 0.25). Predictors for readmission identified included diabetes mellitus, psychological disorders, renal failure, and experiencing diabetes insipidus during the index admission.

Conclusion

Unplanned readmission is an important quality metric. While transsphenoidal pituitary surgery is a relatively safe procedure, 30-day readmission rates and costs have not declined. Future studies on institutional protocols targeting these identified predictors to prevent readmission are necessary to decrease readmission rates on a national scale.

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Fig. 1

Used with permission from Barrow Neurological Institute, Phoenix, Arizona

Fig. 2

Used with permission from Barrow Neurological Institute, Phoenix, Arizona

Fig. 3
Fig. 4

Used with permission from Barrow Neurological Institute, Phoenix, Arizona

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Abbreviations

aOR:

Adjusted odds ratio

CI:

Confidence interval

CSF:

Cerebrospinal fluid

ICD-9-CM:

International Classification of Diseases, Ninth Revision, Clinical Modification

NRD:

Nationwide Readmissions Database

OR:

Odds ratio

SIADH:

Syndrome of inappropriate anti-diuretic hormone

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Acknowledgements

The authors would like to thank the staff of the Neuroscience Publications office at Barrow Neurological Institute for their support.

Disclosures

Dr. Little is a consultant for Spiway and owns stock in Kogent

Funding

Lisa Family Foundation.

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Authors and Affiliations

  1. Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA

    Kelly A. Shaftel, Tyler S. Cole & Andrew S. Little

  2. c/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA

    Andrew S. Little

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  1. Kelly A. Shaftel
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Correspondence to Andrew S. Little.

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Shaftel, K.A., Cole, T.S. & Little, A.S. National trends in hospital readmission following transsphenoidal surgery for pituitary lesions. Pituitary 23, 79–91 (2020). https://doi.org/10.1007/s11102-019-01007-0

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