Delayed Symptomatic Hyponatremia Epidemiology

Delayed hyponatremia following transsphenoidal surgery is a known complication, with a peak incidence of 4-7 days post-operatively 1) 2) 3).

It is a common cause of hospital readmission, due to fluid retention resulting in reduction of plasma sodium concentration below physiologic levels 4).


In a database of 466 consecutive patients who underwent endoscopic transsphenoidal surgery at a tertiary care center between April 2006 and July 2014 was reviewed for 30-day causes for readmission, length of stay, level of care required, and average cost.

Twenty-nine readmissions were identified within the study period, indicating a 30-day readmission rate of 6.2%. Among all patients, rates of 30-day readmission were 2.1% for epistaxis, 1.5% for hyponatremia, 0.9% for cerebrospinal fluid leak, and 1.7% for other medical conditions. Average cost per readmission ranged from $6011 for hyponatremia to $24,613 for cerebrospinal fluid leak 5).


1)
Zada G, Liu CY, Fishback D, Singer PA, Weiss MH. Recognition and management of delayed hyponatremia following transsphenoidal pituitary surgery. J Neurosurg. 2007 Jan;106(1):66-71. PubMed PMID: 17236489.
2)
Hensen J, Henig A, Fahlbusch R, Meyer M, Boehnert M, Buchfelder M. Prevalence, predictors and patterns of postoperative polyuria and hyponatraemia in the immediate course after transsphenoidal surgery for pituitary neuroendocrine tumors. Clin Endocrinol (Oxf). 1999 Apr;50(4):431-9. PubMed PMID: 10468901.
3)
Kelly DF, Laws ER, Jr., Fossett D. Delayed hyponatremia after transsphenoidal surgery for pituitary neuroendocrine tumor. Report of nine cases. J Neurosurg. 1995;83(2):363-367.
4)
Bohl MA, Ahmad S, Jahnke H, et al. Delayed Hyponatremia Is the Most Common Cause of 30-Day Unplanned Readmission After Transsphenoidal Surgery for Pituitary Tumors. Neurosurgery. 2015.
5)
Hendricks BL, Shikary TA, Zimmer LA. Causes for 30-Day Readmission following Transsphenoidal Surgery. Otolaryngol Head Neck Surg. 2016 Feb;154(2):359-65. doi: 10.1177/0194599815617130. Epub 2015 Nov 17. PubMed PMID: 26577772.
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