This retrospective study provides an outpatient care pathway to screen and manage delayed hyponatremia which the study identified as the primary cause of readmission following transsphenoidal pituitary surgery. Of the 303 patients who were studied, 27 were readmitted within 30 days and 15 of the 27 patients had delayed hyponatremia. Other causes for readmission were diabetes insipidus, adrenal insufficiency, cerebrospinal fluid leak, epistaxis, cardiac arrhythmia, pneumonia, urinary tract infection and hypoglycemia.
The authors recommend screening for hyponatremia within seven days of surgery as patients reach the nadir of their sodium levels around the seventh day postop.
Earlier identification helps to manage the sodium levels on an outpatient basis with fluid restriction and salt supplementation and decreases the incidence of readmission. They also recommend using a corticosteroid-sparing protocol to decrease readmission rates for adrenal insufficiency. This study and similar others to follow highlight the importance of providing safe and cost effective health care in the modern era.
