Transsphenoidal surgery for pituitary tumours: frequency and predictors of delayed hyponatraemia and their relationship to early readmission

Jesper Krogh; Caroline N Kistorp; Bahram Jafar-Mohammadi; Aparna Pal; Simon Cudlip; Ashley Grossman

doi:10.1530/eje-17-0879

Transsphenoidal surgery for pituitary tumours: frequency and predictors of delayed hyponatraemia and their relationship to early readmission

Jesper Krogh, Caroline N Kistorp, Bahram Jafar-Mohammadi, Aparna Pal, Simon Cudlip, Ashley Grossman

Department of Clinical Medicine

13 Citations (Scopus)

Abstract

OBJECTIVE: A major cause of readmission after transsphenoidal surgery (TSS) is delayed hyponatraemia. The purpose of this study was to identify predictors of hyponatraemia one week post surgery and predictors of 30-day readmissions for hyponatraemia.

DESIGN: A retrospective cohort study including patients who had TSS performed for pituitary lesions.

METHOD: The risk of readmission for hyponatraemia was assessed in consecutive patients between January 2008 and March 2016. The risk of hyponatraemia one week post surgery was assessed in patients admitted for TSS between July 2011 and March 2016.

RESULTS: Of all included patients, 56/522 (10.7%) were readmitted within 30 days. Hyponatraemia was found in 14/56 (25%) of 30-day readmissions. We did not identify any predictive variable for hyponatraemia on readmission. The number of patients with hyponatraemia on the seventh post-operative day was 26/314 (8.3%). The risk of hyponatraemia one week post surgery was increased by an odds ratio of 2.40 (95% CI: 1.06-5.40) in patients with a tumour abutting the optic chiasm and by an odds ratio of 1.16 (1.04-1.31) per mmol/L decrease in sodium levels on the first post-operative day.

CONCLUSIONS: Hyponatraemia occurred in 25% of readmissions; however, we did not identify any predictive variable for readmission with hyponatraemia. One week post surgery, 8.9% had hyponatraemia. Tumours pressing on the optic chiasm as well as a fall in sodium levels on the first post-operative day were associated with an increased risk of hyponatraemia one week post surgery. We suggest that a day 7 serum sodium <130 nmol/L should lead to concern and the provision of patient advice.

Original language	English
Journal	European Journal of Endocrinology
Volume	178
Issue number	3
Pages (from-to)	247-253
Number of pages	7
ISSN	0804-4635
DOIs	https://doi.org/10.1530/eje-17-0879
Publication status	Published - Mar 2018

Keywords

Adenoma/surgery
Adult
Aged
Cohort Studies
Female
Humans
Hyponatremia/epidemiology
Logistic Models
Male
Middle Aged
Multivariate Analysis
Neurosurgical Procedures
Patient Readmission/statistics & numerical data
Pituitary Neoplasms/surgery
Postoperative Complications/epidemiology
Retrospective Studies
Sphenoid Bone
Sphenoid Sinus

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Transsphenoidal surgery for pituitary tumours : frequency and predictors of delayed hyponatraemia and their relationship to early readmission. / Krogh, Jesper; Kistorp, Caroline N; Jafar-Mohammadi, Bahram et al.

In: European Journal of Endocrinology, Vol. 178, No. 3, 03.2018, p. 247-253.

Research output: Contribution to journal › Journal article › Research › peer-review

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title = "Transsphenoidal surgery for pituitary tumours: frequency and predictors of delayed hyponatraemia and their relationship to early readmission",

abstract = "OBJECTIVE: A major cause of readmission after transsphenoidal surgery (TSS) is delayed hyponatraemia. The purpose of this study was to identify predictors of hyponatraemia one week post surgery and predictors of 30-day readmissions for hyponatraemia.DESIGN: A retrospective cohort study including patients who had TSS performed for pituitary lesions.METHOD: The risk of readmission for hyponatraemia was assessed in consecutive patients between January 2008 and March 2016. The risk of hyponatraemia one week post surgery was assessed in patients admitted for TSS between July 2011 and March 2016.RESULTS: Of all included patients, 56/522 (10.7%) were readmitted within 30 days. Hyponatraemia was found in 14/56 (25%) of 30-day readmissions. We did not identify any predictive variable for hyponatraemia on readmission. The number of patients with hyponatraemia on the seventh post-operative day was 26/314 (8.3%). The risk of hyponatraemia one week post surgery was increased by an odds ratio of 2.40 (95% CI: 1.06-5.40) in patients with a tumour abutting the optic chiasm and by an odds ratio of 1.16 (1.04-1.31) per mmol/L decrease in sodium levels on the first post-operative day.CONCLUSIONS: Hyponatraemia occurred in 25% of readmissions; however, we did not identify any predictive variable for readmission with hyponatraemia. One week post surgery, 8.9% had hyponatraemia. Tumours pressing on the optic chiasm as well as a fall in sodium levels on the first post-operative day were associated with an increased risk of hyponatraemia one week post surgery. We suggest that a day 7 serum sodium <130 nmol/L should lead to concern and the provision of patient advice.",

keywords = "Adenoma/surgery, Adult, Aged, Cohort Studies, Female, Humans, Hyponatremia/epidemiology, Logistic Models, Male, Middle Aged, Multivariate Analysis, Neurosurgical Procedures, Patient Readmission/statistics & numerical data, Pituitary Neoplasms/surgery, Postoperative Complications/epidemiology, Retrospective Studies, Sphenoid Bone, Sphenoid Sinus",

author = "Jesper Krogh and Kistorp, {Caroline N} and Bahram Jafar-Mohammadi and Aparna Pal and Simon Cudlip and Ashley Grossman",

note = "{\textcopyright} 2018 European Society of Endocrinology.",

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TY - JOUR

T1 - Transsphenoidal surgery for pituitary tumours

T2 - frequency and predictors of delayed hyponatraemia and their relationship to early readmission

AU - Krogh, Jesper

AU - Kistorp, Caroline N

AU - Jafar-Mohammadi, Bahram

AU - Pal, Aparna

AU - Cudlip, Simon

AU - Grossman, Ashley

PY - 2018/3

Y1 - 2018/3

N2 - OBJECTIVE: A major cause of readmission after transsphenoidal surgery (TSS) is delayed hyponatraemia. The purpose of this study was to identify predictors of hyponatraemia one week post surgery and predictors of 30-day readmissions for hyponatraemia.DESIGN: A retrospective cohort study including patients who had TSS performed for pituitary lesions.METHOD: The risk of readmission for hyponatraemia was assessed in consecutive patients between January 2008 and March 2016. The risk of hyponatraemia one week post surgery was assessed in patients admitted for TSS between July 2011 and March 2016.RESULTS: Of all included patients, 56/522 (10.7%) were readmitted within 30 days. Hyponatraemia was found in 14/56 (25%) of 30-day readmissions. We did not identify any predictive variable for hyponatraemia on readmission. The number of patients with hyponatraemia on the seventh post-operative day was 26/314 (8.3%). The risk of hyponatraemia one week post surgery was increased by an odds ratio of 2.40 (95% CI: 1.06-5.40) in patients with a tumour abutting the optic chiasm and by an odds ratio of 1.16 (1.04-1.31) per mmol/L decrease in sodium levels on the first post-operative day.CONCLUSIONS: Hyponatraemia occurred in 25% of readmissions; however, we did not identify any predictive variable for readmission with hyponatraemia. One week post surgery, 8.9% had hyponatraemia. Tumours pressing on the optic chiasm as well as a fall in sodium levels on the first post-operative day were associated with an increased risk of hyponatraemia one week post surgery. We suggest that a day 7 serum sodium <130 nmol/L should lead to concern and the provision of patient advice.

AB - OBJECTIVE: A major cause of readmission after transsphenoidal surgery (TSS) is delayed hyponatraemia. The purpose of this study was to identify predictors of hyponatraemia one week post surgery and predictors of 30-day readmissions for hyponatraemia.DESIGN: A retrospective cohort study including patients who had TSS performed for pituitary lesions.METHOD: The risk of readmission for hyponatraemia was assessed in consecutive patients between January 2008 and March 2016. The risk of hyponatraemia one week post surgery was assessed in patients admitted for TSS between July 2011 and March 2016.RESULTS: Of all included patients, 56/522 (10.7%) were readmitted within 30 days. Hyponatraemia was found in 14/56 (25%) of 30-day readmissions. We did not identify any predictive variable for hyponatraemia on readmission. The number of patients with hyponatraemia on the seventh post-operative day was 26/314 (8.3%). The risk of hyponatraemia one week post surgery was increased by an odds ratio of 2.40 (95% CI: 1.06-5.40) in patients with a tumour abutting the optic chiasm and by an odds ratio of 1.16 (1.04-1.31) per mmol/L decrease in sodium levels on the first post-operative day.CONCLUSIONS: Hyponatraemia occurred in 25% of readmissions; however, we did not identify any predictive variable for readmission with hyponatraemia. One week post surgery, 8.9% had hyponatraemia. Tumours pressing on the optic chiasm as well as a fall in sodium levels on the first post-operative day were associated with an increased risk of hyponatraemia one week post surgery. We suggest that a day 7 serum sodium <130 nmol/L should lead to concern and the provision of patient advice.

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KW - Adult

KW - Aged

KW - Cohort Studies

KW - Female

KW - Humans

KW - Hyponatremia/epidemiology

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Neurosurgical Procedures

KW - Patient Readmission/statistics & numerical data

KW - Pituitary Neoplasms/surgery

KW - Postoperative Complications/epidemiology

KW - Retrospective Studies

KW - Sphenoid Bone

KW - Sphenoid Sinus

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DO - 10.1530/eje-17-0879

M3 - Journal article

C2 - 29263154

SN - 0804-4635

VL - 178

SP - 247

EP - 253

JO - Acta Endocrinologica, Supplement

JF - Acta Endocrinologica, Supplement

IS - 3

ER -

Transsphenoidal surgery for pituitary tumours: frequency and predictors of delayed hyponatraemia and their relationship to early readmission

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