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A practical method for prevention of readmission for symptomatic hyponatremia following transsphenoidal surgery

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Abstract

Introduction

Patients undergoing transsphenoidal pituitary surgery (TSS) are at risk for several serious complications, including the syndrome of inappropriate antidiuretic hormone and subsequent hyponatremia.

Objective

In this study, we examined the effect of 1 week of post-discharge fluid restriction to 1.0 L daily on rates of post-operative readmission for hyponatremia.

Methods

We retrospectively analyzed all patients undergoing TSS from 2008 to 2014 and prospectively recorded patient data from 2015 to 2017. Patients were divided into a control cohort (2008–2014), who were discharged with instructions to drink to thirst; and an intervention cohort (2015–2017) who were instructed to drink less than 1.0 L daily for 1 week post-operatively.

Results

This study included 788 patients; 585 (74.2%) in the control cohort and 203 (25.8%) in the intervention cohort. Overall, 436 (55.3%) were women, the median age was 47 (range 15–89), and average BMI was 29.4 kg/m2 (range 17.7–101.7). Patients were relatively well matched. Of patients in the intervention group, none was readmitted for hyponatremia (0/203), compared to 3.41% (20/585) in the control group (p = 0.003). Patients in the intervention group also had significantly higher post-operative week one sodium levels (140.1 vs 137.5 mEq/L; p = 0.002). No fluid balance complications occurred in patients who followed this protocol.

Conclusion

Hyponatremia can be a life-threatening complication of TSS, and prevention of readmission for hyponatremia can help improve patient safety and decrease costs. Mandatory post-discharge fluid restriction is a simple and inexpensive intervention associated with decreased rates of readmission for hyponatremia and normal post-operative sodium levels.

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Funding

National Institutes of Health Training Grant T32 CA 009001 (DJC).

Author information

Author notes

  1. William T. Burke and David J. Cote contributed equally.

Authors and Affiliations

  1. University of Louisville Medical School, Louisville, KY, USA

    William T. Burke

  2. Pituitary/Neuroendocrine Center, Brigham and Women’s Hospital, 60 Fenwood Road, Boston, MA, USA

    William T. Burke, David J. Cote, Sherry I. Iuliano, Hasan A. Zaidi & Edward R. Laws

  3. Harvard Medical School, Boston, MA, USA

    David J. Cote, Sherry I. Iuliano, Hasan A. Zaidi & Edward R. Laws

Authors
  1. William T. Burke
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  2. David J. Cote
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  3. Sherry I. Iuliano
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  5. Edward R. Laws
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Correspondence to Edward R. Laws.

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Burke, W.T., Cote, D.J., Iuliano, S.I. et al. A practical method for prevention of readmission for symptomatic hyponatremia following transsphenoidal surgery. Pituitary 21, 25–31 (2018). https://doi.org/10.1007/s11102-017-0843-5

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