Readmission after Endoscopic Transsphenoidal Pituitary Surgery: Analysis of 584 Consecutive Cases

Objective: Hospital readmission is a key component in value-based health care models but there is limited data about the 30-day readmission rate after endonasal endoscopic transsphenoidal surgery (EETS) for pituitary adenoma. The objective of this study is to determine the incidence and identify factors associated with 30-day readmission after EETS for pituitary adenoma. Methods: The authors analyzed a prospectively acquired database of EETS for pituitary adenoma from 2005 to 2018 at New York Presbyterian Hospital, Weill Cornell Medicine. We identified cases of unplanned readmission within 30 days of surgery. As a control group, we reviewed clinical and radiographic data of all other patients in the cohort that were not readmitted. Statistical significance was determined with α < 0.05 using Pearson’s Chi-square and Fisher’s exact tests for categorical variables and the independent-samples t -test for continuous variables. Results: Of 584 patients undergoing EETS for pituitary adenoma, 27 (4.6%) cases had unplanned readmission within 30 days. Most readmissions occurred within the first week after surgery with a mean time to readmission of 6.6 ± 3.9 days. The majority of readmissions (59%) were for hyponatremia. These patients had a mean sodium level of 120.6 ± 4.6 mEq/L at presentation. Other causes of readmission were epistaxis (11%), spinal headache (11%), sellar hematoma (7.4%), cerebrospinal fluid leak (CSF) leak (3.7%), nonspecific headache (3.7%), and pulmonary embolism (3.7%). The postoperative length of stay was significantly shorter for patients that were readmitted compared with the control (2.7 ± 1.0 days vs. 3.9 ± 3.2 days; p < 0.05). The mean body mass index (BMI) was significantly lower for readmitted patients compared with the control (26.4 ± 3.9 vs. 29.3 ± 6.1 kg/m 2 ; p < 0.05). Conclusion: Readmission after EETS for pituitary adenoma is a relatively rare phenomenon with delayed hyponatremia being the primary cause. We found that a shorter postoperative length of stay and lower BMI were associated with 30-day readmission.