November 27, 2019
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National readmission rate remains at 10% after pituitary surgery

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The national 30-day unplanned readmission rate following transsphenoidal surgery for pituitary lesion held at 10.4% between 2010 and 2015, despite a national focus on reducing readmission rates, according to findings from a database analysis published in Pituitary.

In an analysis of records from more than 40,000 patients across 27 states, the researchers also found that the most common cause for 30-day readmission was hyponatremia and that diabetes status was a significant readmission predictor.

“To date, nationwide trends in unplanned readmission following transsphenoidal surgery for pituitary lesions have not been examined in depth,” Andrew Little, MD, director of the Pituitary Center and the Skull Base Program at Barrow Neurological Institute in Phoenix, and colleagues wrote in the study background. “Furthermore, consistent predictors of readmission have not been determined in their entirety.”

In a retrospective study, Little and colleagues analyzed data from 44,759 adults who underwent transsphenoidal surgery for pituitary lesion resection between 2010 and 2015, using the Nationwide Readmissions Database, a database of readmission rates from participating hospitals in 27 states. Researchers calculated national trends and statistical variances based on weighted, clustered and stratified sample means.

During the 6-year period, 4,658 patients (10.4%) were readmitted within 30 days. Readmission rates did not change across the survey period.

“That the readmission rate did not change over our survey period suggests continued opportunity for improvement and dissemination of best practices across centers,” the researchers wrote.

In the univariate analysis, readmission was associated with female sex (P = .005), as well as a diagnosis of Cushing’s disease, neoplasms of uncertain behavior, or malignant neoplasms of the pituitary gland and craniopharyngeal duct; admission through the ED; higher severity of illness; and transfer to a long-term facility after discharge (P < .001 for all).

“Notably, patient age was not associated with readmission; even though there was a higher percentage of individuals in the readmission group (25.5%) than in the nonreadmission group (22.4%) among those older than 65 years of age, these results were not statistically different from those for the other age groups,” the researchers wrote.

Researchers found that readmitted patients had a higher prevalence of comorbidities compared with those who were not readmitted (82.5% vs. 78.4%; P < .001), experienced more postoperative complications (47.2% vs. 31.8%; P < .001), and had a longer length of stay during their index admission (6.59 vs. 4.23 days; P < .001).

The most common causes for readmission were syndrome of inappropriate antidiuretic hormone (SIADH; 17.5%) and other hyponatremia (16.4%), as well as other neurologic complications (16.8%) and diabetes insipidus (14.7%).

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Average total readmission cost was $12,080 (95% CI, 11,070-13,090) with no significant trend across the study period.

Most readmitted patients experienced a single unplanned readmission within 30 days; however, between 6.6% and 9.8% of these patients also experienced a second readmission within 30 days of the index admission each year, and 0.4% to 0.9% of these patients were readmitted a third time within the same 30-day period, the researchers noted.

Predictors for readmission included diabetes, psychological disorders, renal failure and experiencing diabetes insipidus during the index admission.

“Our results corroborated some of the independent predictors for readmission identified in previous studies while also bringing to light other predictors that need to be taken into consideration when providing high-quality care to patients,” the researchers wrote. “Unanswered questions include the impact of certain recently applied readmission reduction efforts for this patient population, such as prophylactic fluid restriction. Special attention should be paid to proven strategies that improve quality, such as subspecialty teams and establishing a national registry to track patient outcomes and disseminate best practices.” – by Regina Schaffer

Disclosures: The Lisa Family Foundation funded this study. Little reports he owns stock in Kogent and is a consultant for Spiway.