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Abstract：
Background Thirty-day unplanned readmission following endoscopic transsphenoidal pituitary surgery (ETPS) occurs in up to 14% of patients. Delayed hyponatremia is one of the most common causes, accounting for 30% of readmissions and often occurs within 1 week of surgery. The authors\' prior retrospective review identified endocrinology follow-up as protective factor. Objectives Implementation of a multidisciplinary postoperative care (POC) pathway: (1) to reduce 30-day hospital readmissions following ETPS and (2) improve inpatient and outpatient coordination of care with endocrinologist. Methods This study is a single institution temporal cohort study of patients prior to (control cohort) and after implementation of the POC pathway (intervention cohort). The POC pathway utilized postdischarge 1 to 1.5 L/d fluid restriction, postoperative days 5 to 7 serum sodium, and endocrinology follow-up within 1 week of discharge to stratify patients into tiered hyponatremia regimens. Results A total of 542 patients were included in the study, 409 (75%) in the control cohort and 133 (25%) in the intervention cohort. All-cause readmission was significantly reduced following implementation of the POC pathway (14 vs. 6%, p = 0.015). Coordination with endocrinologist significantly increased in the inpatient (96 vs. 83%, p < 0.001) and outpatient (77 vs. 68%, p = 0.042) settings. Patients who were not in the POC pathway had the highest risk of readmission (odds ratio: 2.5; 95% confidence interval: 1.1-5.5). Conclusion A multidisciplinary POC pathway incorporating endocrinologist in conjunction with postdischarge weight-based fluid restriction and postoperative serum sodium levels can safely be used to reduce 30-day readmissions following ETPS.
摘要：
背景：内镜经蝶窦垂体手术（ETPS）后30天的非计划再入院发生在多达14％的患者中。迟发性低钠血症是最常见的原因之一，占30％的再入院，通常发生在手术后1周内。作者先前的回顾性研究将内分泌学随访确定为保护因素。目的实施多学科术后护理（POC）途径：（1）减少ETPS后30天的住院再入院；（2）改善住院和门诊与内分泌科医生的协调护理。方法本研究是对实施POC途径之前（对照队列）和之后（干预队列）的患者进行的单机构时间队列研究。POC途径利用放电后1至1.5L/d流体限制，术后第5至7天血清钠，出院后1周内内分泌学随访，将患者分层为分层低钠血症方案。结果共纳入542例患者,对照组为409（75％），干预队列为133（25％）。实施POC途径后，全因再入院显着降低（14与6%,p=0.015)。住院患者与内分泌学家的协调显着增加（96vs.83%,p<0.001）和门诊患者（77vs.68%,p=0.042)设置。不在POC途径的患者再次入院的风险最高（比值比：2.5；95％置信区间：1.1-5.5）。结论将多学科POC途径纳入内分泌学家，结合基于出院后体重的液体限制和术后血清钠水平，可以安全地减少ETPS后30天的再入院。
