Factors Associated with 30-Day Readmission after Endoscopic Transsphenoidal Surgery: The Critical Role of Dedicated Endocrinology Discharge Coordination

Objectives: To identify demographic, clinical, and operative factors of unplanned 30-day readmission following endoscopic transsphenoidal surgery (ETS). Design: Single-center retrospective study. Setting: Tertiary academic medical center based in New York, NY. Participants: A total of 386 adult patients who underwent nonemergent ETS for pituitary adenomas between March 2009 and May 2020. Main Outcome Measures: The primary outcome was 30-day unplanned hospital admission. Clinical and demographic characteristics were analyzed using χ2- and student t-tests. For factors with p-value < 0.1, multivariate logistic regression models were constructed to estimate the adjusted odds of 30-day readmission across predictive factors. Results: Of 386 patients who received ETS, 29 (7.5%) patients required readmission within 30 days of discharge. Eleven (2.8%) patients were readmitted for complications related to electrolyte derangements (SIADH, hyponatremia), followed by 5 (1.3%) patients with epistaxis. On multivariate analysis, pituitary microadenomas (p=0.032), transient diabetes insipidus (p=0.021), and preoperative visual cranial nerve palsies (CN III/IV/VI; p=0.019) were associated with increased odds of 30-day readmission. Conclusions: Patients with pituitary microadenomas, transient diabetes insipidus, and preoperative cranial nerve palsies were at an increased risk for unplanned 30-day readmission after ETS. Dedicated neuro-endocrinology involvement is necessary in the postoperative period to reduce readmission risk in these patients. Identification and careful monitoring of these at-risk populations is necessary, as targeted post-discharge care may prevent readmission and improve both patient and hospital outcomes.