Readmission and Other Adverse Events after Transsphenoidal Surgery: Prevalence, Timing, and Predictive Factors.

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Readmission and Other Adverse Events after Transsphenoidal Surgery: Prevalence, Timing, and Predictive Factors.

J Am Coll Surg. 2017 Mar 06;:

Authors: Cote DJ, Dasenbrock HH, Muskens IS, Broekman ML, Zaidi HA, Dunn IF, Smith TR, Laws ER

Abstract
BACKGROUND: Transsphenoidal surgery is a common neurosurgical procedure for accessing the pituitary and anterior skull base, yet few multicenter analyses have evaluated outcomes after this procedure.
STUDY DESIGN: Patients undergoing transsphenoidal surgery from 2006 to 2015 were extracted from the ACS NSQIP database. Logistic regression was used to identify predictors of thirty-day complications.
RESULTS: Of 1240 patients included in this analysis; 6.9% experienced a major complication, and 9.4% experienced any complication within 30 days. Other adverse events included death in 0.7% and non-routine hospital discharge in 5.3%. Most adverse events occurred within the first two weeks post-operatively; 82.9% of patients experienced their first complication during the initial hospital stay. Multivariable analysis demonstrated that predictors of hospital stay longer than four days included American Society of Anesthesiologists (ASA) classification III-V (P=0.015), insulin-dependent diabetes mellitus (P<0.001) and operative time in the third and fourth quartiles (both P<0.001). ASA classification III-V and operative time in the fourth quartile were also predictors of any adverse event (P=0.01 and P=0.005, respectively). Among these patients, 3.7% underwent reoperation, the most common reason for which was post-operative cerebrospinal fluid (CSF) leak (63.6%). Readmission occurred after 8.5% of cases at a median of 11.0 days post-discharge. The most common cause of readmission was hyponatremia (29.5%), followed by delayed post-operative CSF leak (16.0%).
CONCLUSIONS: Overall rates of adverse events in patients undergoing transsphenoidal surgery are relatively low, and most occur prior to discharge from the hospital. Post-discharge complications associated with transsphenoidal surgery include deep vein thrombosis, pulmonary embolism, and urinary tract infection. Delayed post-operative CSF leak is the major cause of reoperation, and hyponatremia is the major cause of readmission.

PMID: 28279778 [PubMed - as supplied by publisher]

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