Introduction: Complications and unplanned hospital readmissions contribute to the national healthcare expenditure. In response, one area for improvement includes reducing post-operative complications. Though these complications may vary, diabetes insipidus (DI) remains one of the most morbid. While studies have characterized the management of post-operative DI, there are a paucity of data identifying risk factors associated with DI following resection.

Methods: Medical records of 97 consecutive patients undergoing elective trans-sphenoidal pituitary adenoma resection from 2013 to 2015 were reviewed. Patients were categorized as “Older” (age =55, n=45) and “Younger” (age <55, n=52). Patient demographics, comorbidities, adenoma characteristics, and intra- and post-operative complication rates were collected. The primary outcome measure was the incidence of post-operative DI. A nominal multivariate logistic regression was used to determine whether age was an independent risk factor.

Results: Patient demographics were similar between cohorts, with the expected significant difference in age (Older: 66.6±8.4 vs. Younger: 39.9±11.5, p<0.0001). Older cohort had a significantly greater proportion of patients with coronary artery disease, hypertension, and hyperlipidemia. There were significant differences in adenoma subtype between cohorts, with those secreting prolactin more frequent in Younger patients (p=0.0002). a-HCG and ß-HCG tumors were more prevalent in Older patients (p=0.004 and p=0.002, respectively). Post-operatively, the Younger cohort had significantly higher incidences of DI than the Older cohort (23.1% vs. 2.2%, p=0.003). Multivariate regression analysis demonstrated age <55 proved independently associated with post-operative DI, with a 12.7-fold increase in risk [OR: 12.7, 95% CI (1.516, 106.2), p=0.02].

Conclusions: Interestingly, our study suggests that not only is age independently and strongly associated with increased risk of DI following pituitary adenoma resection, but this risk is seen in younger patients. Further studies are necessary to characterize this risk, as well as to identify additional patient risk factors that may also serve as independent predictors of post-operative DI following pituitary adenoma resection.

Patient Care: By identifying a patient risk factors for unplanned 30 day readmissions, providers may be able to optimize patient care strategies to reduce readmissions and improve the overall quality of patient care.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of examining factors driving readmissions following pituitary adenoma resection, 2) Discuss, in small groups, both drivers of readmission as well as opportunities to avoid unplanned postoperative readmissions, 3) Identify effective interventions to avoid patient readmissions following pituitary adenoma resection.

References: 1. Bohl, Michael A., Shah Ahmad, Heidi Jahnke, Deborah Shepherd, Laura Knecht, William L. White, and Andrew S. Little. 2016. “Delayed Hyponatremia Is the Most Common Cause of 30-Day Unplanned Readmission After Transsphenoidal Surgery for Pituitary Tumors.” Neurosurgery 78 (1): 84–90. 2. Hendricks, Brian L., Tasneem A. Shikary, and Lee A. Zimmer. 2015. “Causes for 30-Day Readmission Following Transsphenoidal Surgery.” Otolaryngology--Head and Neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery 154 (2). SAGE Publications Inc: 359–65. 3. Shah, Manish N., Ivan T. Stoev, Dominic E. Sanford, Feng Gao, Paul Santiago, David P. Jaques, and Ralph G. Dacey Jr. 2013. “Are Readmission Rates on a Neurosurgical Service Indicators of Quality of Care?” Journal of Neurosurgery 119 (4): 1043–49. 4. Thomas, Jonathan G., Nisha Gadgil, Susan L. Samson, Masayoshi Takashima, and Daniel Yoshor. 2014. “Prospective Trial of a Short Hospital Stay Protocol after Endoscopic Endonasal Pituitary Adenoma Surgery.” World Neurosurgery 81 (3-4): 576–83. 5. Zada, Gabriel, Charles Y. Liu, Dawn Fishback, Peter A. Singer, and Martin H. Weiss. 2007. “Recognition and Management of Delayed Hyponatremia Following Transsphenoidal Pituitary Surgery.” Journal of Neurosurgery 106 (1): 66–71.