Factors Associated with 30-Day Readmissions after Transsphenoidal Pituitary Surgery

Highlights•The majority of the readmissions occurred within the first week after discharge.•Patients requiring readmission had a significantly longer mean index length of hospital stay, and a significantly greater proportion developed Diabetes Insipidus (DI) during the index hospital stay compared to individuals not readmitted.•Occurrence of postoperative DI and greater medical complexity of the patient (as measured by Medicare Severity Diagnosis Related Group-MS-DRG) were associated with a greater 30-day readmission risk after pituitary surgery.•Close monitoring of patients at higher risk for developing diabetes insipidus and interventions such as Enhanced Recovery After Surgery (ERAS) protocols to shorten the length of stay may help decrease readmissions after pituitary surgery.AbstractPurposeDetermine the association between clinical and demographic factors and 30-day readmission risk after pituitary surgery.MethodsPatients undergoing pituitary surgery between January 2018 and December 2022 were retrospectively reviewed. Cases were extracted from a converged electronic health record that included surgeries performed at the Midwest, Southeast, and Southwest campuses of the same healthcare Enterprise. Variables were compared between patients with 30-day readmission following discharge after pituitary surgery (N=83) and a randomly sampled patient cohort with pituitary surgery but no readmission within 30 days (N=174).ResultsIn a multivariable regression model looking at the relationship between patient characteristics and readmission risk, every increase in the Medicare Severity Diagnosis Related Group score resulted in a nearly 2.3-fold increase in the risk of readmission (OR=2.335, 95% CI 1.050, 5.562, p=0.045). The presence of AVP deficiency increased the odds of readmission by more than 2-fold (OR=2.784, 95% CI 1.118, 7.124, p=0.029). The Midwest site was observed to have a nearly 67% decrease in readmission risk compared to the Southwest site (OR=0.334, 95% CI 0.134, 0.813, p=0.016), with the Southeast site being comparable to the Southwest.ConclusionOur study identifies postoperative AVP deficiency, greater co-morbidities, and geographic location as risk factors for 30-day readmission after pituitary surgery. Further investigation is required to determine how site-specific care processes can be adopted to lower readmission risk at other locations in the same healthcare enterprise.