Delayed Symptomatic Hyponatremia in Transsphenoidal Surgery: Systematic Review and Meta-Analysis of Its Incidence and Prevention with Water Restriction

Objective: Delayed symptomatic hyponatremia (DSH) is an unpredictable postoperative complication after transsphenoidal pituitary surgery. Universal postoperative sodium screening and water restriction are two strategies to prevent the development of DSH. We performed a meta-analysis of studies characterizing the rate of DSH using sodium screening and water restriction protocols.

Methods: A systematic literature review was performed using MEDLINE/PUBMED, EMBASE, and Cochrane databases. Inclusion criteria were (1) adult patients >18 years of age, (2) development of DSH after endoscopic or microscopic transsphenoidal, sellar surgery, and (3) reporting of a standardized postoperative sodium screening protocol for monitoring or prevention of DSH.

Results: A total of 23 publications fulfilled the inclusion criteria and combined with our institutional experience resulted in 24 studies with 6,596 patients in total. Of the 20 studies examining the rate of DSH after sodium screening, DSH rates ranged from 0 to 19.7%. Using a random-effect estimate of the combined proportions, the overall rate of DSH was 5.12% (3.76–6.48%, I ² = 96.64%, T2 = 0.0006). A fixed-effect model of four studies examining the rate of DSH before and after water restriction showed an odds ratio (OR) of 5.02 (95% CI: 2.16–11.65) favoring water restriction.

Conclusion: This meta-analysis summarizes rates of DSH with sodium screening protocol and shows a decreased risk of DSH after implementation of a water restriction protocol. The results are limited due to few studies examining fluid restriction (N = 4). No adverse events were seen with the fluid restriction protocol. Prospective and multicenter studies should be conducted to investigate the utility of water restriction after surgery.

Publikationsverlauf

Artikel online veröffentlicht:
15. Februar 2022