Abstract
Introduction Postoperative delayed hyponatremia is a complication associated with transsphenoidal pituitary surgery. Due to a wide spectrum of symptoms, the reported incidence and predictors of postoperative delayed hyponatremia vary among studies, and this deserves to be reviewed systematically. Methods PubMed, EMBASE, and CENTRAL databases were searched until September 1, 2020. Studies were included when (1) the event number of delayed hyponatremia after transsphenoidal pituitary surgery was reported, or (2) the associated factors of such complication were evaluated. Results A total of 27 studies were included for meta-analysis. The pooled incidence of overall and symptomatic delayed hyponatremia was 10.5% (95% confidence interval (CI) = 7.4–14.7%) and 5.0% (95% CI = 3.6–6.9%), respectively. No overt variations of the pooled estimates were observed upon subgroups stratified by endoscopic and microscopic procedure, publication year, and patients' age. In addition, 44.3% (95% CI = 29.6–60.2%) of unplanned hospital readmissions within 30 days were caused by delayed hyponatremia. Among the predictors evaluated, older age was the only significant factor associated with increased delayed hyponatremia (odds ratio = 1.16, 95% CI = 1.04–1.29, P = 0.006). Conclusion This meta-analysis and systematic review evaluated the incidence of postoperative delayed hyponatremia and found it as a major cause of unplanned readmissions after transsphenoidal pituitary surgery. Older patients are more prone to such complications and should be carefully followed. The retrospective nature and heterogeneity among the included studies and the small number of studies used for risk factor evaluation might weaken the corresponding results. Future prospective clinical studies are required to compensate for these limitations.
Highlights
Postoperative delayed hyponatremia is a complication associated with transsphenoidal pituitary surgery
Postoperative delayed hyponatremia was reported to be a common cause for unexpected hospital readmissions after transsphenoidal pituitary tumour surgery [2, 8], and preventive measures have been implemented to reduce these events [9,10,11]
10 of the 27 studies were published before 2011 [4, 21, 22, 25, 26, 28, 31, 32, 34, 37], with the remaining studies published later [6, 9,10,11,12,13, 18,19,20, 23, 24, 27, 29, 30, 33, 35, 36]; 3 of the 27 studies were prospective studies, whereas the others were conducted retrospectively [4, 6, 9,10,11,12,13, 18,19,20, 22, 23, 25,26,27,28,29,30, 32,33,34,35,36,37] (Table 1). e study size of the 27 included studies was between 84 and 2297 patients, encompassing a total of 11,356 patients. e mean age of patients ranged from 42 to 54 years, and the proportion of males was 32%–63%. e pathological tumour types varied among studies, with nonfunctioning pituitary adenoma as the major type
Summary
Postoperative delayed hyponatremia is a complication associated with transsphenoidal pituitary surgery. Studies were included when (1) the event number of delayed hyponatremia after transsphenoidal pituitary surgery was reported, or (2) the associated factors of such complication were evaluated. Is meta-analysis and systematic review evaluated the incidence of postoperative delayed hyponatremia and found it as a major cause of unplanned readmissions after transsphenoidal pituitary surgery. Postoperative delayed hyponatremia was reported to be a common cause for unexpected hospital readmissions after transsphenoidal pituitary tumour surgery [2, 8], and preventive measures have been implemented to reduce these events [9,10,11]. As such, identifying patients with increased risk of developing delayed hyponatremia is critical to the postoperative care of transsphenoidal pituitary surgery [12,13,14]
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