Return to the Emergency Room with or without Readmission After Endoscopic Transsphenoidal Surgery in Socioeconomically Disadvantaged Patients at an Urban Medical Center

Silva, Nicole A.; Taylor, Brittany L.; Herendeen, John; Reddy, Rajiv P.; Eloy, Jean Anderson; Liu, James K.

doi:10.1016/j.wneu.2018.12.039

Cited by 5 publications

(6 citation statements)

References 23 publications

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“…11 Within the context of postoperative ED visits, pathology, the use of expanded endoscopic corridors (e.g., transtuberculum/transplanum), presence of an intraoperative CSF leak (whether low flow or high flow), and postoperative complications did not appear to affect the likelihood of discharge or readmission from the ED. Importantly, hyponatremia and electrolyte abnormalities were the most common reasons for readmission while benign headache was the most common discharge diagnosis, findings corroborated by Silva et al 10 Hyponatremia has been recognized as a leading contributor to unplanned readmissions. [12][13][14] There has been mixed success with implementing postoperative endocrine monitoring care pathways with some groups reporting improvements in 30day readmission 15 and others reporting improved rates of identifying patients with hyponatremia, but no reduction in 30-day readmissions.…”

Section: Discussionsupporting

confidence: 63%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

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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“…Though the reasons for readmissions following eTNTS have been studied, few have looked closely at the reasons for patient phone calls, messages, and emergency department (ED) visits and how these contribute to readmissions and patient satisfaction. 2,7 In the time between discharge and the first follow-up visit, patients often resort to telephone calls or messages via the electronic medical record (EMR) system as the first step in contacting their surgeons with concerns in the postoperative period. 8 As has been demonstrated within other surgical and nonsurgical disciplines, understanding the nature of postoperative phone calls may lead to reduction of ED or urgent care facilities use and provide guidance for improvement in overall patient satisfaction ratings.…”

Section: Introductionmentioning

confidence: 99%

“…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. 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.…”

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

Vengerovich

Park

Antoury

et al. 2019

Int Forum Allergy Rhinol

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BackgroundUnplanned readmissions within 30 days of discharge is a quality measure introduced by the Centers for Medicare Services. This measure has been used to rate hospital quality and also to penalize hospitals for excess readmissions. It has been hypothesized that shorter hospital stays and fewer readmissions are associated with endoscopic skull base procedures. In this study we analyze endoscopic skull base procedures performed at our institution over a 10‐year period to identify rates and factors associated with readmissions after endoscopic skull base surgery.MethodsA retrospective chart review was performed at a tertiary care academic medical center identifying patients who underwent endoscopic skull base surgery over the past 10 years. Data on patient demographics and tumor variables, as well as patient variables such as body mass index (BMI), revision surgery, history of skull base radiation, medical comorbidities, intraoperative cerebrospinal fluid (CSF) leaks, and postoperative CSF leaks, were recorded.ResultsEight hundred thirty‐three patients were included in our study. Sixty‐one patients (7.3%) were readmitted a total of 66 times within 30 days. The most common reasons were as follows: hyponatremia (n = 18); CSF leak (n = 17); epistaxis (n = 3); diabetes insipidus (n = 3); rhinorrhea (n = 3); as well as other reasons. Statistical analysis revealed that the presence of intraoperative CSF leak was the only statistically significant variable associated with increased rate of readmissions within 30 days of discharge (p < 0.001).ConclusionPresence of intraoperative CSF leak was the only statistically significant variable associated with an increased risk for readmission after surgery. Other tumor and patient variables were not associated with an increased risk of readmission within 30 days.

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Return to the Emergency Room with or without Readmission After Endoscopic Transsphenoidal Surgery in Socioeconomically Disadvantaged Patients at an Urban Medical Center

Cited by 5 publications

References 23 publications

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

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

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

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

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