Delayed symptomatic hyponatremia in transsphenoidal surgery: Systematic review and meta-analysis of its incidence and prevention with water restriction

Siyuan Yu; Mohammad Taghvaei; Maikerly Reyes; Keenan Piper; Sarah Collopy; John P Gaughan; Giyarpuram N Prashant; Michael Karsy; James J Evans

doi:10.1016/j.clineuro.2022.107166

Delayed symptomatic hyponatremia in transsphenoidal surgery: Systematic review and meta-analysis of its incidence and prevention with water restriction

Clin Neurol Neurosurg. 2022 Mar:214:107166. doi: 10.1016/j.clineuro.2022.107166. Epub 2022 Feb 10.

Authors

Siyuan Yu¹, Mohammad Taghvaei², Maikerly Reyes³, Keenan Piper², Sarah Collopy², John P Gaughan⁴, Giyarpuram N Prashant², Michael Karsy², James J Evans²

Affiliations

¹ Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: Siyuan.Yu@jefferson.edu.
² Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
³ Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA; Cooper Research Institute, Cooper University Hospital, Camden, NJ, USA.
⁴ Cooper Research Institute, Cooper University Hospital, Camden, NJ, USA.

PMID: 35158166
DOI: 10.1016/j.clineuro.2022.107166

Abstract

Background: Delayed symptomatic hyponatremia (DSH) is an unpredictable postoperative complication after transsphenoidal pituitary surgery. Universal postoperative sodium screening and water restriction are two strategies to detect or 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: Literature search was done using MEDLINE/PUBMED, EMBASE, and Cochrane databases. Inclusion criteria are (1) development of DSH after endoscopic or microscopic transsphenoidal, sellar surgery, and (2) reporting of a standardized postoperative sodium screening protocol for monitoring or prevention of DSH.

Results: A total of 23 publications fulfilled the inclusion criteria resulted in a total of 5870 patients. Two meta-analyses were conducted. Of the 19 studies (N = 4488 patients) examining rate of DSH after sodium screening, DSH rates ranged from 0% to 19.7%. In the first meta-analysis, using a random-effect estimate of the combined proportions, the overall rate of DSH was 5.60% (4.0%-7.1%, I² = 96.54%, T² = 0.0007). In the second meta-analysis, a fixed-effect model of four studies consisted of 1382 patients. Eight hundred fifty-two patients were included prior to and 530 were included after water restriction protocol. Meta-analysis showed an odds ratio (OR) of 5.02 (95% CI: 2.16-11.65) favoring water restriction.

Conclusion: This meta-analysis summarized rates of DSH with sodium screening protocol to be 5.60% (4.0%-7.1%) and showed 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) and heterogeneity in water restriction protocols. No adverse events were seen with fluid restriction protocol. Prospective and multicenter studies should be conducted to further investigate the utility of water restriction following transsphenoidal pituitary surgery.

Keywords: Delayed symptomatic hyponatremia; Pituitary adenoma; Screening protocol; Transsphenoidal surgery.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Humans
Hyponatremia* / diagnosis
Hyponatremia* / epidemiology
Hyponatremia* / etiology
Incidence
Pituitary Neoplasms* / diagnosis
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Postoperative Complications / prevention & control
Prospective Studies
Retrospective Studies
Sodium
Water

Substances

Water
Sodium