title: Risk factors for 30-day hospital readmission after thyroidectomy and parathyroidectomy in the United States: An analysis of National Surgical Quality Improvement Program outcomes.
abstract: BACKGROUND
  The 30-day readmission rate is a quality metric under the Affordable Care Act. Readmission rates after thyroidectomy and parathyroidectomy and associated factors remain ill-defined. We evaluated patient and perioperative factors for association with readmission after thyroidectomy and parathyroidectomy.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program Participant Use File (2011) data for thyroid (n = 3,711) and parathyroid (n = 3,358) resections were analyzed. Patient- and operation-related factors were assessed by univariate and multivariate analyses.
  
  
  RESULTS
  Among 7,069 patients, 30-day readmission rate was 4.0%: 4.1% after thyroidectomy and 3.8% after parathyroidectomy. Significant associations for 30-day readmission included declining functional status (odds ratio [OR], 6.4-10.1), preoperative hemodialysis (OR, 2.6; 95% CI, 1.5-4.7), malnutrition (OR, 3.4; 95% CI, 1.2-10.1), increasing American Society of Anesthesiologists class (OR 1.3-4.7), unplanned reoperation (OR, 61.6), and length of stay (LOS) <24 hours (OR, 0.61; 95% CI, 0.45-0.85; all P < .05). Readmission was associated with greater total and postoperative LOS and major postoperative complications, including renal insufficiency (all P < .01).
  
  
  CONCLUSIONS
  Thirty-day readmission after cervical endocrine resection occurs in 4% of patients. Discharge within 24 hours of operation does not affect the likelihood of readmission. Risk factors for readmission are multifactorial and driven by preoperative conditions. Decreasing the index hospital stay and preventing major postoperative complications may decrease readmissions and improve quality metrics.
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, University of Virginia, Charlottesville, VA.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Mullen
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, University of Virginia, Charlottesville, VA.
authors.forename: Damien J
authors.initials: DJ
authors.lastname: LaPar
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, University of Virginia, Charlottesville, VA.
authors.forename: Sara K
authors.initials: SK
authors.lastname: Daniel
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, University of Virginia, Charlottesville, VA.
authors.forename: Florence E
authors.initials: FE
authors.lastname: Turrentine
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, University of Virginia, Charlottesville, VA.
authors.forename: John B
authors.initials: JB
authors.lastname: Hanks
authors.affiliation: Section of Endocrine Surgery, Division of General Surgery, University of Virginia, Charlottesville, VA. Electronic address: philipsmith@virginia.edu.
authors.forename: Philip W
authors.initials: PW
authors.lastname: Smith
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000009:adverse effects* / Q000379:methods; D010351:Patient Discharge / Q000706:statistics & numerical data; D058991:Patient Protection and Affordable Care Act; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011379:Prognosis; D058996:Quality Improvement; D012307:Risk Factors; D012737:Sex Factors; D018709:Statistics, Nonparametric; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods; D013997:Time Factors; D014481:United States