A Simple Scoring System for Predicting the Risk of Delayed Hyponatremia After Endoscopic Transsphenoidal Surgery for Pituitary Adenomas

To identify high-risk patients for delayed postoperative hyponatremia (DPH) early, we constructed a simple and effective scoring system. We retrospectively analyzed 141 consecutive patients who underwent endoscopic transsphenoidal surgery (TSS) from January 2019 to December 2022. Patients were divided into DPH group and non-DPH (NDPH) group based on whether hyponatremia occurred after the third postoperative day. Multivariable logistic regression analysis was conducted to determine the predictive factors of DPH, and a simple scoring system was constructed based on these predictors. Among 141 patients, 36 (25.5%) developed DPH. Multivariable logistic regression analysis showed that age ≥48 years (OR, 3.74; 95%CI, 1.14-12.21; P=0.029), Knosp grade ≥3 (OR, 5.17; 95%CI, 1.20-22.27; P=0.027), postoperative hypokalemia within three days (OR, 3.13; 95%CI, 1.05-9.33; P=0.040), a difference in blood sodium levels between the first and second day after surgery ≥1 mEq/L (OR, 3.65; 95%CI, 1.05-12.77; P=0.043), and postoperative diabetes insipidus (OR, 3.57; 95%CI, 1.16-10.96; P=0.026) were independent predictors of DPH. This scoring system for predicting DPH has an area under the receiver operating characteristic curve (AUC) of 0.856 (95%CI, 0.787-0.925), indicating moderate to good predictive value for DPH in our cohort, but further prospective external validation is needed.