Abstract
Background: Thirty-day unplanned readmission following endoscopic transsphenoidal pituitary surgery (ETPS) occurs in up to 14% of patients. Delayed hyponatremia is one of the most common causes, accounting for 30% of readmissions and often occurs within 1 week of surgery. The authors prior retrospective review identified endocrinology follow up as protective factor.
Objectives: Implementation of a multidisciplinary post-operative care pathway (POC pathway): (a) to reduce 30-day hospital readmissions following ETSP; (b) improve inpatient and outpatient coordination of care with endocrinologist.
Methods: Single institution temporal cohort study of patients prior to (control cohort) and after implementation of the POC pathway (intervention cohort). The POC pathway utilized post-discharge 1-1.5L/day fluid restriction, a post-operative day 5-7 serum sodium, and endocrinology follow up within 1 week of discharge to stratify patients into tiered hyponatremia regimens.
Results: 542 patients were included in the study, 409 (75%) in the control cohort and 133 (25%) in the intervention cohort. All cause readmission was significantly reduced following implementation of the POC pathway (14% vs 6%, p=0.015). Coordination with endocrinologist significantly increased in the inpatient (96% vs. 83%, p <0.001)) and outpatient (77% vs. 68%, p=0.042) setting. Patients who were not in the POC pathway had the highest risk of readmission (OR: 2.5; 95% CI: 1.1-5.5).
Conclusions: A multidisciplinary POC pathway incorporating endocrinologist in conjunction with post-discharge weight-based fluid restriction and post-operative serum sodium levels can safely be used to reduce 30-day readmissions following ETPS.
