Thyroid and parathyroid operations in veterans affairs and selected university medical centers: results of the patient safety in surgery study.
BACKGROUND
There is increasing interest in surgical outcomes. The Patient Safety in Surgery (PSS) Study database was examined about thyroid and parathyroid procedures to determine risk factors for adverse outcomes and outcomes rates. Relative outcomes performance for the Veterans Affairs (VA) and private-sector populations was compared after risk adjustment.


METHODS
Preoperative, operative, and postoperative data were analyzed for 7,082 patients: 2,814 VA patients and 4,268 private sector patients. Prevalence of risk or process factors was described. Occurrence rates and unadjusted odds ratios (OR) for adverse outcomes were calculated. Stepwise multiple logistic regressions were performed to model the impact of various factors on outcomes and to calculate the adjusted OR for any adverse event for the VA population compared with the private sector.


RESULTS
Overall mortality rate was 0.35% and 0.60% in the VA and 0.19% in the private sector. Overall rate of any adverse outcomes was 2.90% and 4.48% in the VA and 1.97% in the private sector. Adjusted OR for thyroid versus parathyroid operation was 0.94 (95% CI, 0.67-1.31). Adjusted OR for operation in the VA versus private sector was 1.25 (95% CI, 0.87-1.78).


CONCLUSIONS
Overall rates of mortality and any morbidity were low and consistent with previous reports. Based on adjusted OR, there was no significant difference in outcomes for thyroid versus parathyroid operation. Similarly, there was no apparent significant difference in surgical outcomes between the VA and private-sector groups after risk adjustment.
Hall
Bruce Lee
BL
Department of Surgery, School of Medicine, Washington University, St Louis, MO 63110, USA. hallb@wustl.edu
Hirbe
Mitzi
M
Yan
Yan
Y
Khuri
Shukri F
SF
Henderson
William G
WG
Hamilton
Barton H
BH
D013507:Endocrine Surgical Procedures / Q000401:mortality*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D017149:Private Sector; D012044:Regression Analysis; D012307:Risk Factors; D012449:Safety; D013961:Thyroid Gland / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States