A practical method for prevention of readmission for symptomatic hyponatremia following transsphenoidal surgery
| Autor: | Edward R. Laws, David J. Cote, William T. Burke, Hasan A. Zaidi, Sherry Iuliano |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Adolescent Endocrinology Diabetes and Metabolism medicine.medical_treatment Drinking 030209 endocrinology & metabolism Patient Readmission Thirst Inappropriate ADH Syndrome 03 medical and health sciences Young Adult 0302 clinical medicine Endocrinology Pituitary adenoma Risk Factors Internal medicine medicine Humans In patient Aged Hypophysectomy Retrospective Studies Transsphenoidal surgery Aged 80 and over business.industry Middle Aged medicine.disease Treatment Outcome Anesthesia Pituitary Gland Cohort Female medicine.symptom business Hyponatremia Complication 030217 neurology & neurosurgery Antidiuretic |
| Zdroj: | Pituitary. 21(1) |
| ISSN: | 1573-7403 |
| Popis: | Patients undergoing transsphenoidal pituitary surgery (TSS) are at risk for several serious complications, including the syndrome of inappropriate antidiuretic hormone and subsequent hyponatremia. In this study, we examined the effect of 1 week of post-discharge fluid restriction to 1.0 L daily on rates of post-operative readmission for hyponatremia. We retrospectively analyzed all patients undergoing TSS from 2008 to 2014 and prospectively recorded patient data from 2015 to 2017. Patients were divided into a control cohort (2008–2014), who were discharged with instructions to drink to thirst; and an intervention cohort (2015–2017) who were instructed to drink less than 1.0 L daily for 1 week post-operatively. This study included 788 patients; 585 (74.2%) in the control cohort and 203 (25.8%) in the intervention cohort. Overall, 436 (55.3%) were women, the median age was 47 (range 15–89), and average BMI was 29.4 kg/m2 (range 17.7–101.7). Patients were relatively well matched. Of patients in the intervention group, none was readmitted for hyponatremia (0/203), compared to 3.41% (20/585) in the control group (p = 0.003). Patients in the intervention group also had significantly higher post-operative week one sodium levels (140.1 vs 137.5 mEq/L; p = 0.002). No fluid balance complications occurred in patients who followed this protocol. Hyponatremia can be a life-threatening complication of TSS, and prevention of readmission for hyponatremia can help improve patient safety and decrease costs. Mandatory post-discharge fluid restriction is a simple and inexpensive intervention associated with decreased rates of readmission for hyponatremia and normal post-operative sodium levels. |
| Databáze: | OpenAIRE |
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