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A Multicenter Study of Unplanned Hospital Readmissions after Transsphenoidal Surgery for Cushing's Disease
Mark A Pacult1, Michael Karsy2, James J Evans3
1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States.
Insights
Hospital readmission rates after Cushing's disease surgery are similar to other pituitary disorders. Hyponatremia is the most common cause, highlighting the need for focused clinical protocols to improve patient outcomes.
Area of Science:
- Neurosurgery
- Endocrinology
- Patient Outcomes
Background:
- Cushing's disease surgery may lead to higher hospital readmissions compared to other pituitary disorders.
- Understanding readmission patterns is crucial for improving patient care and healthcare system efficiency.
Purpose of the Study:
- To investigate the rates, causes, and predictors of unplanned 90-day hospital readmissions following transsphenoidal surgery for Cushing's disease.
- To identify areas for clinical, financial, and administrative improvements in managing patients post-surgery.
Main Methods:
- Retrospective cohort study involving 519 patients who underwent transsphenoidal surgery for Cushing's disease.
- Data collected from academic pituitary centers in the US participating in a multicenter surgical outcome registry (2003-2023).
- Analysis of unplanned 90-day readmission rates and their primary causes.
Main Results:
- The unplanned 90-day readmission rate was 11.0% (57/519 patients).
- Most common causes included hyponatremia (21%), cerebrospinal fluid leak (14%), and epistaxis (10%).
- While univariate analysis suggested factors like no tumor on MRI and inpatient complications were associated with readmission, no predictors were significant on multivariate analysis.
Conclusions:
- Readmission rates for Cushing's disease surgery are comparable to other pituitary disorders, with hyponatremia being the leading cause.
- Implementing targeted clinical protocols for hyponatremia management may reduce readmission risk.
- Identifying high-risk patient cohorts remains challenging despite a large dataset.
Objectives:
Patients undergoing surgery for Cushing's disease may be more likely to be readmitted to the hospital than other patients with pituitary disorders. We investigated rates, causes, and predictors of unplanned readmission following transsphenoidal surgery for Cushing's disease to identify areas for clinical, financial, and administrative improvements.
Design:
Retrospective cohort study.
Setting:
Academic pituitary centers in the United States participating in a multicenter surgical outcome registry.
Participants:
Five hundred and nineteen patients underwent transsphenoidal surgery for treatment of Cushing's disease by 26 surgeons at nine participating institutions from 2003 to 2023.
Main Outcome Measures:
Unplanned 90-day readmission rates and causes of readmission.
Results:
Unplanned readmissions occurred in 57/519 patients (11.0%), with hyponatremia in 12/57 (21%), cerebrospinal fluid leak evaluation in 8/57 (14%), epistaxis in 6/57 (10%), deep vein thrombosis in 4/57 (7%), syncope in 3/57 (5%), and headache in 3/57 (5%). Factors including no tumor on initial magnetic resonance imaging, return to the operating room during the index admission, lack of early remission, and inpatient complications were associated with a greater probability of readmission on univariate analysis. However, none remained predictive on multivariate analysis.
Conclusion:
Our results show that readmission rates after transsphenoidal surgery for Cushing's disease are comparable to previously reported rates for all pituitary-related disorders, with the most common reason being hyponatremia. High-impact clinical protocols focused on preventing delayed hyponatremia may reduce the risk of readmission. Failure to identify significant predictors of readmission, even in this large clinical dataset, underscores the challenge of identifying high-risk clinical cohorts.
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