Risk factors associated with complications and 30-day readmission in endoscopic endonasal transsphenoidal surgery: a single-institution retrospective analysis

Purpose: There is a recent trend towards rapid discharge after endoscopic endonasal transsphenoidal surgery (EETS). We aimed to identify factors related to in-hospital complications and 30-day readmissions to help inform postoperative care practices. Methods: : This is a retrospective analysis of patients that underwent EETS for resection of a tumor. Primary outcomes included complications and 30-day readmission. Results: : Transient diabetes insipidus occurred in 37% of patients with a complication. Complication was associated with bedrest, occurring in 15.4% of patients without no bedrest, in 24.5% of patients with bedrest of 2-3 days, and in 54.6% of patients with >3 days of bedrest (p=0.02). The median length of stay was 6 days and 4 days in patients with and without a complication, respectively (p<0.0001). Readmission within 30 days occurred in 9.5% of cases, most commonly due to hyponatremia. 30-day readmission was associated with American Society of Anesthesiologists (ASA) class, where 12.5%, 5.9%, and 37.5% patients with ASA class 2, 3, and 4 were readmitted in 30 days, respectively (p=0.02). A maximum tumor diameter (TDmax) of 20-29 mm was associated with readmission, occurring in 20.9% of those patients (p=0.01). EOR was not associated with postoperative complication or with 30-day readmission. Conclusion: In-hospital complication was associated with increased duration of postoperative bedrest, although no causative relationship can be established based on this data. Preoperative anticoagulation usage, increasing ASA class, and TDmax 20-29 mm may help predict 30-day readmission after EETS. EOR was not associated with complications or 30-day readmission.