Readmissions after endoscopic skull base surgery: associated risk factors and prevention

Vengerovich, Gennadiy; Park, Ki Wan; Antoury, Layal; Wells, Christine; Suh, Jeffrey D.; Lee, Jivianne T.; Heaney, Anthony P.; Bergsneider, Marvin; Wang, Marilene B.

doi:10.1002/alr.22453

Cited by 7 publications

(13 citation statements)

References 18 publications

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“…As previously demonstrated, these complications are the most common reasons for readmission. 1,[10][11][12] Our overall readmission rate of 9% falls within the commonly identified range of 5.6 to 9% seen in other studies. 1,3 With regard to postdischarge patient communication (call or message), we found that over half of the patients had at least one postdischarge communication prior to the first postoperative visit.…”

Section: Discussionsupporting

confidence: 83%

“…1,[10][11][12] Our overall readmission rate of 9% falls within the commonly identified range of 5.6 to 9% seen in other studies. 1,3 With regard to postdischarge patient communication (call or message), we found that over half of the patients had at least one postdischarge communication prior to the first postoperative visit. The majority of communications were related to logistical questions (42%) or new symptoms (34%).…”

Section: Discussionsupporting

confidence: 83%

“…Endoscopic transnasal transsphenoidal (eTNTS) surgery has become the primary technique for the removal of pituitary adenomas and other sellar region tumors. 1 This procedure has been demonstrated to be safe and effective, particularly when compared with open approaches. 2 3 4 As endoscopic techniques improve alongside surgeon experience and institutional familiarity, hospital stays continue to decrease.…”

Section: Introductionmentioning

confidence: 99%

“…In general, patients are discharged from the hospital 1 to 5 days after surgery and are scheduled for their first follow-up appointment within 2 weeks of discharge. 1 3 5 While this has led to a reduction in costs associated with prolonged hospital stays, studies have shown the quick turnaround time is associated with a higher risk of readmission within 30 days. 1 3 6 This quality improvement metric is of particular importance because hospital readmissions within 30 days of discharge account for $17 billion in unplanned Medicare expenditures, and 30-day readmission rate is one of the fundamental measures of quality of care in the Affordable Care Act.…”

Section: Introductionmentioning

confidence: 99%

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

Harary

Bommakanti

Nakhla

et al. 2022

J Neurol Surg B Skull Base

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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.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Harary

Bommakanti

Nakhla

et al. 2022

J Neurol Surg B Skull Base

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“…Readmission rates after endoscopic transsphenoidal surgery have been cited to range from 5.6-9.0% [12]. In the COVID-19 era, there is even additional scrutiny on readmission, again due to the shortage of inpatient beds and the need to minimize exposure to other patients.…”

Section: Postoperative Considerationsmentioning

confidence: 99%

Reintroducing Endoscopic Skull Base Surgery During the COVID-19 Pandemic: A Single-Center Experience from the United States COVID-19 Epicenter

Maragkos¹,

McNeill²,

Kessler³

et al. 2021

Journal of Scientific Innovation in Medicine

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Background:The COVID-19 pandemic presented unique challenges for endoscopic skull base surgery (ESBS) given the elevated viral load in the nasopharynx and aerosolization of particles inherent to the endoscopic endonasal approach (EEA). Furthermore, reports and anecdotes shared within the skull base surgeon community suggesting potential elevated risk of COVID-19 transmission during ESBS led to an abundance of precaution and scrutiny regarding endonasal procedures during the pandemic. The Mount Sinai Hospital is a busy ESBS center located in New York City, the United States COVID-19 pandemic epicenter. We report a case series describing the early experience of resuming ESBS during the COVID-19 pandemic, including systems for case selection, surgical precautions and modifications, and patient outcomes.Methods: All consecutive ESBS cases and deferred surgical cases were identified prospectively within the first three-week period after resumption of urgent scheduled surgery. Data regarding indications, pre-surgical screening, operative results, and postoperative course were collected retrospectively. All data are presented using descriptive statistics.Results: With the study time frame, 14 patients underwent ESBS. Four patients had surgery deferred. The mean age was 57. The most common pathology was pituitary tumor, in 57% of patients. Visual symptoms precipitated the urgency in 36% of cases. All patients underwent COVID-19 screening with a minimum of one SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) nasal swab within 48 hours preceding surgery. All patients tested negative. There were no intraoperative complications. Median length of stay was two days. A total of 14% of patients experienced postoperative complications. Mean follow-up was 100.9 days.

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

Godse

Jarmula

Kshettry

et al. 2023

Int Forum Allergy Rhinol

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BackgroundReadmissions are major healthcare expenditures, key hospital metrics, and are often preceded by an evaluation in the emergency department (ED). The purpose of this study was to analyze ED visits within 30 days of endoscopic skull base surgery (ESBS), risk factors for readmission once in the ED, and ED‐related evaluation and outcomes.MethodsRetrospective review from January 2017 to December 2022 at a high‐volume center of all ESBS patients who presented to the ED within 30 days of surgery.ResultsOf 593 ESBS cases, 104 patients (17.5%) presented to the ED following surgery within 30 days, with a median presentation of 6 days post‐discharge (IQR 5–14); 54 (51.9%) patients were discharged while 50 (48.1%) were readmitted. Readmitted patients were significantly older than discharged patients (median 60 years, IQR 50–68 vs. 48 years, 33–56; p < 0.01). Extent of ESBS was not associated with readmission or discharge from the ED. The most common discharge diagnoses were headache (n = 13, 24.1%) and epistaxis (n = 10, 18.5%); the most common readmitting diagnoses were serum abnormality (n = 15, 30.0%) and altered mental status (n = 5, 10.0%). Readmitted patients underwent significantly more laboratory testing than discharged patients (median 6, IQR 3–9 vs. 4, 1–6; p < 0.01).ConclusionsApproximately half of patients who presented to the ED following ESBS were discharged home but underwent significant workup. Follow‐up within 7 days of discharge, risk‐stratified endocrine care pathways, and efforts to address the social determinants of health may be considered to optimize postoperative ESBS care.

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Readmissions after endoscopic skull base surgery: associated risk factors and prevention

Cited by 7 publications

References 18 publications

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

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

Reintroducing Endoscopic Skull Base Surgery During the COVID-19 Pandemic: A Single-Center Experience from the United States COVID-19 Epicenter

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

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