J. L. Buicko1, J. P. Parreco1, M. A. Lopez1, R. A. Kozol1 1University Of Miami,Palm Beach General Surgery Residency,Atlantis, FL, USA
Introduction:
Readmission rates after surgery receive significant attention as a measurement of quality of patient care. According to a recent study in the New England Journal of Medicine, almost one in seven patients hospitalized for a major surgical procedure were readmitted within 30 days of discharge. The morbidity and mortality of parathyroidectomy is low and readmission data is poorly characterized in the literature. Our objective is to identify national readmission rates after parathyroidectomy and to characterize reasons and risk factors for readmission after parathyroidectomy.
Methods:
The Nationwide Readmission Database (NRD) was queried for all patients undergoing parathyroidectomy in 2013 who survived the initial admission. Multivariate logistic regression was then implemented using patient comorbidities and demographics as well as hospital characteristics to determine the odds ratios (OR) for nonelective readmission within 30 days.
Results:
During the study period, 4,082 patients underwent parathyroidectomy and 357 (8.7%) had nonelective readmissions within 30 days. The most common primary diagnoses on initial admission were benign neoplasm of parathyroid gland (1,232, 30.2%) and primary hyperparathyroidism (899, 22.0%). There were 772 patients (18.9%) with a diagnosis of secondary hyperparathyroidism and these patients had an OR for readmission of 2.38 (p<0.01, 95% CI 1.77 to 3.22). The most common primary diagnoses on readmission were hypocalcemia (57, 8.0%) and hungry bone syndrome (31, 4.3%). The comorbidities associated with the highest ORs for readmission were weight loss (OR 3.08, p<0.01, 95% CI 1.88 to 5.03), renal failure (OR 2.37, p<0.01, 95% CI 1.79 to 3.13), and congestive heart failure (OR 2.13, p<0.01, 95% CI 1.47 to 3.08).
Conclusion:
Overall, 8.9% of patients who underwent parathyroidectomy had a nonelective readmission. Hypocalcemia and hungry bone syndrome were the most common reasons for readmission. As thirty-day readmission rates are frequently used as a quality metric for patient care, identifying risk factors for readmission is of paramount importance, and efforts should be made to reduce readmission rates for these patient groups at higher risk.