TY - JOUR
T1 - Fluid Restriction After Transsphenoidal Surgery for the Prevention of Delayed Hyponatremia
T2 - A Systematic Review and Meta-Analysis
AU - Perez-Vega, Carlos
AU - Tripathi, Shashwat
AU - Domingo, Ricardo A.
AU - Ramos-Fresnedo, Andres
AU - Lee, Seung J.
AU - Chaichana, Kaisorn L.
AU - Quinones-Hinojosa, Alfredo
AU - Samson, Susan L.
N1 - Publisher Copyright:
© 2021 AACE
PY - 2021/9
Y1 - 2021/9
N2 - Objective: Delayed hyponatremia is the primary cause of readmission after transsphenoidal surgery, with a reported incidence of 9% to 30.7%. Studies have failed to identify consistent predictive factors for postoperative hyponatremia; thus, it is difficult to determine patients that are at a high risk. Fluid restriction is one approach for the prevention of hyponatremia. We have performed a meta-analysis and systematic review of the literature to evaluate the impact of fluid restriction on hyponatremia and hospital readmissions. Methods: Ovid EMBASE, PubMed, Scopus, and Cochrane were searched from inception to May 2021, using the Population, Intervention, Comparison, Outcome, and Study question format: Do patients who underwent transsphenoidal surgery and followed a postoperative fluid restriction regimen differ in terms of hyponatremia and readmission rates? Studies that implemented fluid restriction and reported hyponatremia and/or readmission rates were included for analysis. Data were pooled by meta-analysis and analyzed using fixed effect and random effect models. Results: A total of 143 manuscripts representing 103 unique studies were identified, with 5 studies included for analysis, yielding a pooled cohort of 1586 patients: 594 on fluid restriction protocols and 992 control patients. Fluid restriction protocols ranged from 1.0 to 2.5 L and varied in the length time between postoperative days 1 to 15. Patients on fluid restriction had a decreased risk of hyponatremia (risk ratio: 0.34; 95% CI, 0.21-0.57; P <.00001) and readmission due to hyponatremia (risk ratio: 0.24; 95% CI, 0.09-0.63; P =.0038). Conclusion: Postoperative fluid restriction after transsphenoidal surgery represents an effective method for the prevention of hyponatremia and hospital readmission and has the potential to decrease health care costs.
AB - Objective: Delayed hyponatremia is the primary cause of readmission after transsphenoidal surgery, with a reported incidence of 9% to 30.7%. Studies have failed to identify consistent predictive factors for postoperative hyponatremia; thus, it is difficult to determine patients that are at a high risk. Fluid restriction is one approach for the prevention of hyponatremia. We have performed a meta-analysis and systematic review of the literature to evaluate the impact of fluid restriction on hyponatremia and hospital readmissions. Methods: Ovid EMBASE, PubMed, Scopus, and Cochrane were searched from inception to May 2021, using the Population, Intervention, Comparison, Outcome, and Study question format: Do patients who underwent transsphenoidal surgery and followed a postoperative fluid restriction regimen differ in terms of hyponatremia and readmission rates? Studies that implemented fluid restriction and reported hyponatremia and/or readmission rates were included for analysis. Data were pooled by meta-analysis and analyzed using fixed effect and random effect models. Results: A total of 143 manuscripts representing 103 unique studies were identified, with 5 studies included for analysis, yielding a pooled cohort of 1586 patients: 594 on fluid restriction protocols and 992 control patients. Fluid restriction protocols ranged from 1.0 to 2.5 L and varied in the length time between postoperative days 1 to 15. Patients on fluid restriction had a decreased risk of hyponatremia (risk ratio: 0.34; 95% CI, 0.21-0.57; P <.00001) and readmission due to hyponatremia (risk ratio: 0.24; 95% CI, 0.09-0.63; P =.0038). Conclusion: Postoperative fluid restriction after transsphenoidal surgery represents an effective method for the prevention of hyponatremia and hospital readmission and has the potential to decrease health care costs.
KW - SIADH
KW - fluid restriction
KW - hyponatremia
KW - pituitary adenoma
KW - transsphenoidal
UR - http://www.scopus.com/inward/record.url?scp=85111529339&partnerID=8YFLogxK
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U2 - 10.1016/j.eprac.2021.07.003
DO - 10.1016/j.eprac.2021.07.003
M3 - Review article
C2 - 34265453
AN - SCOPUS:85111529339
SN - 1530-891X
VL - 27
SP - 966
EP - 972
JO - Endocrine Practice
JF - Endocrine Practice
IS - 9
ER -