Causes for 30-day readmission following transsphenoidal surgery

Objective The Affordable Care Act Readmissions Reduction Program introduced reimbursement policy changes resulting in penalties for hospitals with higher-than-average readmission rates among several categories, including elective surgical cases. We examined the rate of complications resulting in 30-day readmission following endoscopic transsphenoidal surgery. Study Design Case series with chart review. Setting Academic tertiary care center. Methods A database of 466 consecutive patients who underwent endoscopic transsphenoidal surgery at a tertiary care center between April 2006 and July 2014 was reviewed for 30-day causes for readmission, length of stay, level of care required, and average cost. Results Twenty-nine readmissions were identified within our study period, indicating a 30-day readmission rate of 6.2%. Among all patients, rates of 30-day readmission were 2.1% for epistaxis, 1.5% for hyponatremia, 0.9% for cerebrospinal fluid leak, and 1.7% for other medical conditions. Average cost per readmission ranged from $6011 for hyponatremia to $24,613 for cerebrospinal fluid leak. Conclusion Overall, the rate of 30-day readmission following endoscopic pituitary surgery is low. However, common causes of readmission do add significant cost to the overall care of this patient population. Special attention to surgical technique to prevent epistaxis and cerebrospinal fluid rhinorrhea, as well as multidisciplinary team management to avoid postoperative endocrine dysfunction, is critical to minimize these complications.