A. Rios-Diaz1, R. Zheng1, D. P. Thibault2, J. A. Crispo2, A. W. Willis2, A. I. Willis1 1Thomas Jefferson University,Department Of Surgery,Philadelphia, PA, USA 2University Of Pennsylvania,Department Of Biostatistics And Epidemiology,Philadelphia, PA, USA
Introduction: The 30-day readmission rate is increasingly utilized as a metric of quality impacting reimbursement. To date, there are no national data on readmission rates after thyroid surgery. We aimed to determine national readmission rates and associated clinical factors for patients with thyroidectomy operations at a national level.
Methods: Using the 2014 Nationwide Readmission Database, we identified patients undergoing thyroid surgery as defined by International Classification of Diseases, Ninth Revision, procedure codes for thyroid lobectomy, partial thyroidectomy, complete thyroidectomy and substernal thyroidectomy. Descriptive statistics were used to examine readmission rates, most common causes for readmission and timing of presentation after discharge. Adjusted multivariable logistic regression models controlling for potential confounders were used to determine factors associated with increased 30-day readmission. Statistical significance was set at P < 0.05.
Results: A total of 22,654 patients underwent thyroid surgery in the study period and 990 (4.37%) were readmitted within 30 days. Among these, the most common diagnoses for readmission were "disorders of mineral metabolism" accounting for 36% and "hypocalcemia" for 26.6%. This held true regardless of the indication for surgery (goiter, cancer or thyroid function disorder) or timing of readmission after discharge. Most readmissions (54.6%) occurred within seven days of discharge, with 24.6% within the first 48 hours. Factors associated with increased readmission odds included Medicare insurance (Adjusted Odds Ratio 1.47 [95% Confidence Interval 1.03-2.11]), Medicaid insurance (AOR 1.44 [CI 1.04-1.99]), discharge to inpatient post acute care (AOR 2.31 [CI 1.48-3.62]) or home with home healthcare (AOR 1.78 [CI 1.21-2.63]), Elixhauser comorbidity score ≥ 4 (AOR 2.04 [CI 1.27-3.26]), length of stay ≥ 2 days (AOR 2.7 [CI 1.9-3.82]). Hypocalcemia was the only complication during the index admission that was associated with increased odds of readmission (AOR 1.5 [CI 1.1-2.06]). (All AOR P<0.01). There was no association of diagnosis indication for surgery or type of procedure with odds of readmissions.
Conclusion: A considerable proportion of thyroidectomy patients are readmitted early after thyroid surgery. The most common diagnosis for readmission is hypocalcemia/mineral metabolism disorder. Socioeconomic factors, comorbidities and complications during index admissions are significantly associated with increased readmissions. Recognition of these risk factors may decrease readmission rates as well as guide further policy discussions regarding readmissions.