Audit of Postoperative Readmissions and Patient Messages following Endoscopic Transnasal Transsphenoidal Surgery

Abstract

Objectives:To identify the reasons for patient messages, phone calls and Emergency Department (ED) visits prior to the first postoperative visit following discharge after endoscopic transnasal transsphenoidal (eTNTS) surgery. Design: Retrospective review of patients at a tertiary care academic center who underwent eTNTS for resection of a sellar region tumor between May 2020-August 2021. Patient, tumor, and surgical characteristics were collected, along with post-operative, post-discharge, and readmission information. Regression analyses were performed to investigate risk factors associated with post-discharge phone calls, messages, ED visits, and readmissions. Main Outcome Measures: Number of and reasons for phone calls, patient messages, and ED visits between hospital discharge and the first postoperative visit. We additionally determined whether these reasons were addressed in each patient’s discharge instructions. Results: A total of 98 patients underwent eTNTS during the study period. Median length of hospital stay was 2-days (Interquartile range [IQR] 1-4days), at which point most patients (82%) were provided with eTNTS-specific discharge instructions. First postoperative visit took place 9-days after discharge (IQR 7-10days). Within that time, 54% of patients made/sent at least one phone call or electronic message and 17% presented to the ED. Most common reasons for call/message were nasal care, appointment scheduling, symptom and medication questions. Conclusions: Through this work, we highlight the most common reasons for resource utilization via patient phone calls, messages, and ED visits among our cohort to better understand any shortfall or gap in the discharge process that may reduce these events.

Emergency department visits following endoscopic skull base surgery: An opportunity for improvement

“…A subset of postoperative readmissions are immediately preceded by an evaluation in the emergency department (ED), at which time a decision to discharge or readmit is made. Early work evaluating ED visits following ESBS has suggested some common reasons for early postoperative utilization of the ED, 9,10 and identified the presence and vulnerability of a "silent" population of patients-those who are ultimately discharged following an evaluation in the ED. 10 The purpose of this study was to closely analyze the rates and reasons for visits to the ED within 30 days of surgery, risk factors for readmission once in the ED, the workup and evaluation undertaken in the ED, and the characteristics of patients who were ultimately discharged versus readmitted.…”