Introduction: Although reducing 30-day hospital readmission is now a priority in neurosurgical quality improvement, postoperative emergency room (ER) visits remain poorly understood, particularly in populations with limited access to outpatient care. After endoscopic transsphenoidal surgery (ETS), the unique pathologies treated may engender a variety of surgical, endocrine, and metabolic complications—often dangerous, delayed, and non-specific in presentation. We sought to characterize the causes and timing of ER visits—with or without readmission—in this socioeconomically disadvantaged population, and to compare this to national data.

Methods: We retrospectively reviewed all patients undergoing ETS by our skull base team from 2009-2017 to determine the causes of 30-day readmission and ER visits. Demographic details, tumor characteristics (Table 1), and endocrine function were reviewed. For external validation, we compared results to national data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP).

Results: Of the 229 patients who underwent ETS, 35 (15.3%) visited the ER within 30 days of discharge, of whom 21 (9.2%) were readmitted. The most common reasons for ER visits (Figure 1) were headache (22.9%), hyponatremia (20.0%), and epistaxis (14.3%). Six were readmitted for symptomatic hyponatremia (28.6%), of whom only two had a perioperative sodium <135mmol/L. Other reasons for readmission included meningitis (9.52%), adrenal crisis (9.52%), and, rarely, CSF leak (4.76%). Average time to readmission was 10.9 days (Figure 2), and 5.67 days for hyponatremia readmissions. Nationally, 9 of 163 patients (5.52%) were readmitted, of which 22.2% were for hyponatremia.

Conclusions: Delayed hyponatremia accounts for a large proportion of readmissions and occurs early after discharge. However, only a minority of these patients exhibit such characteristics perioperatively. Our study suggests that close follow-up with diligent, multidisciplinary care may reduce ER visits and readmission in this population, however more national data is needed to ultimately lessen patient morbidity and healthcare costs.

Patient Care: Reducing 30-day readmission following transsphenoidal surgery warrants further investigation for appropriate intervention and prevention. Even more, ER visits are poorly described in the literature following transsphenoidal surgery. Our results shed light on our institutional and national data.

Learning Objectives: 1. Elucidate primary causes of 30-day readmissions and emergency room visits following transsphenoidal surgery for sellar lesions in a socioeconomically disadvantaged population 2. Understand and treat the surgical and metabolic complications following sellar tumor removal. 3. Analyze our hospital readmission rates relative to the national data in order to better treat patients following transsphenoidal surgery.

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