Causes of emergency department visits following thyroid and parathyroid surgery

• Published in: JAMA otolaryngology-- head & neck surgery Vol. 139; no. 11; p. 1175
• Main Authors: Young, William G, Succar, Eric, Hsu, Linda, Talpos, Gary, Ghanem, Tamer A
• Format: Journal Article
• Language: English
• Published: United States 01.11.2013
• Subjects: Comorbidity; Emergency Service, Hospital - statistics & numerical data; Female; Follow-Up Studies; Hospitalization - statistics & numerical data; Humans; Male; Michigan - epidemiology; Middle Aged; Parathyroid Diseases - epidemiology; Parathyroid Diseases - surgery; Parathyroidectomy; Postoperative Care - statistics & numerical data; Retrospective Studies; Risk Factors; Tertiary Care Centers - statistics & numerical data; Thyroid Diseases - epidemiology; Thyroid Diseases - surgery; Thyroidectomy; Michigan
• ISSN: 2168-619X
• DOI: 10.1001/jamaoto.2013.4505

With reimbursement being increasingly tied to outcome measures, minimizing unexpected health care needs in the postoperative period is essential. This article describes reasons for emergency department (ED) evaluation, rates of readmission to the hospital, and significant risk factors for readmission during the postoperative period. To describe the subset of patients requiring ED evaluation within 30 days of thyroidectomy or parathyroidectomy and their associated risk factors. Retrospective chart review in a tertiary care center of adult patients who underwent thyroidectomy or parathyroidectomy between January 1, 2009 and October 7, 2010. Patients were identified from an institutional review board-approved database. Postoperative patients who visited the emergency department (ED) within the first 30 days following surgery were selected and compared with the postoperative patients who did not visit the ED. Thyroidectomy or parathyroidectomy. Statistical analysis evaluated the association of demographic and clinical characteristics between the patients who required ER evaluation and those who did not. Clinical characteristics evaluated included type of surgery, medical comorbidities, and proton pump inhibitor (PPI) usage. Multiple logistic regression predicted the odds of an ED visit based on presence of diabetes, gastroesophageal reflux disease (GERD), or PPI use. Of the 570 patients identified, 64 patients required a visit to the ER a total of 75 times for issues including paresthesias (n = 28), wound complications (n = 8), and weakness (n = 6). Fifteen hospital admissions occurred for treatment of a variety of postoperative complications. A significant association was found between the presence of diabetes (P = .03), GERD (P = .04), and the current use of PPIs (P = .03). When controlling for diabetes and GERD, we found that patients taking PPIs were 1.81 times more likely to visit the ED than patients not taking PPIs (P = .04). Patients taking PPIs are 1.81 times more likely to require ED evaluation than those who are not taking PPIs.