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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
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An Effective and Practical Fluid Restriction Protocol to Decrease the Risk of Hyponatremia and Readmissions After

Dina Winograd1, Kristen A Staggers2, Sherly Sebastian3,4

  • 1Department of Medicine, Section of Endocrinology, Baylor College of Medicine, Houston, Texas.

Neurosurgery
|January 30, 2020
PubMed
Summary
This summary is machine-generated.

Fluid restriction significantly reduces delayed hyponatremia after transsphenoidal surgery (TSS). A 1000-mL fluid restriction from postoperative days 4 to 8 eliminated hyponatremia cases and readmissions in a study cohort.

Keywords:
Diabetes insipidusFluid restrictionHyponatremiaPituitary adenomaSellaTranssphenoidal

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Area of Science:

  • Neurosurgery
  • Endocrinology
  • Patient Safety

Background:

  • Delayed hyponatremia is a frequent complication after transsphenoidal surgery (TSS) for pituitary lesions.
  • This complication leads to increased patient morbidity and hospital costs due to readmissions.

Purpose of the Study:

  • To evaluate the effectiveness of a 4-day fluid restriction in reducing hyponatremia rates and readmissions post-TSS.
  • To identify patient factors associated with the risk of hyponatremia and readmissions.

Main Methods:

  • A 1000-mL fluid restriction was implemented for postoperative days 4 to 8 in patients undergoing TSS.
  • Outcomes (hyponatremia, readmissions) were compared between patients with and without fluid restriction.
  • Patient data, including body mass index, gender, hormone staining, and glucocorticoid use, were analyzed.

Main Results:

  • The rate of hyponatremia before fluid restriction was 12.3%.
  • Following implementation of fluid restriction, zero cases of hyponatremia or readmissions were observed.
  • Lower body mass index, male gender, specific hormone staining (FSH/LH), and glucocorticoid use were associated with a decreased risk of hyponatremia and readmissions.

Conclusions:

  • A 1000-mL fluid restriction between postoperative days 4 and 8 is a highly effective and simple strategy.
  • This approach significantly decreases the risk of delayed hyponatremia following transsphenoidal surgery.