Fluid Restriction Reduces Delayed Hyponatremia and Hospital Readmissions After Transsphenoidal Surgery.

Cooper, Odelia; Lis, Rita; Bonert, Vivien; Labadzhyan, Artak; Ning-Ai Liu; Ben-Shlomo, Anat; Ljubimov, Vladimir; Krutikova, Viktoria; Mamelak, Adam N.

Context: Postoperative hyponatremia leads to prolonged hospital length of stay and readmission within 30 days. Objective: To assess 3 strategies for reducing rates of postoperative hyponatremia and analyze risk factors for hyponatremia. Design: Two retrospective analyses and 1 prospective study. Setting: Tertiary referral hospital. Patients: Patients undergoing transsphenoidal surgery for pituitary adenomas and other sellar and parasellar pathologies. Intervention(s): Phase 1: no intervention. Phase 2: postoperative day (POD) 7 sodium testing and patient education. Phase 3: fluid restriction to 1 L/day on discharge in addition to phase 2 interventions. Main outcome measures: Rates of early and delayed hyponatremia and readmissions. Secondary outcomes were risk factors for hyponatremia and readmission costs. Results: In phase 1, 296 patients underwent transsphenoidal surgery. Twenty percent developed early and 28% delayed hyponatremia. Thirtyeight percent underwent POD 7 sodium testing. Readmission rates were 15% overall and 4.3% for hyponatremia. In phase 2 (n=316), 22% developed early and 25% delayed hyponatremia. Eighty-nine percent complied with POD 7 sodium testing. Readmissions were unchanged although severity of hyponatremia was reduced by 60%. In phase 3 (n=110), delayed hyponatremia was reduced 2-fold [12.7%, relative risk (RR) =0.52] and readmissions 3-fold [4.6%, RR=0.30 (0.12–0.73)]; readmissions for hyponatremia were markedly reduced. Hyponatremia readmission increased costs by 30%. Conclusions: Restricting fluid to 1 L/day on discharge decreases rates of delayed hyponatremia and readmissions by 50%. Standardized patient education and POD 7 sodium testing decreases severity of hyponatremia but does not impact readmission rates. These protocols should be considered standard practice for patients undergoing transsphenoidal surgery.

POSTOPERATIVE care; HYPONATREMIA; HOSPITALS

Journal of Clinical Endocrinology & Metabolism, 2023, Vol 108, Issue 8, pe623

0021-972X

Academic Journal

10.1210/clinem/dgad066