title: Factors Predictive of Emergency Department Visits and Hospitalization Following Thyroidectomy and Parathyroidectomy.
abstract: BACKGROUND
  This study aimed to determine the incidence and risk factors for emergency department (ED) visits and unplanned hospitalization after thyroid and parathyroid surgery.
  
  
  METHODS
  A retrospective study of all patients who underwent thyroidectomy or parathyroidectomy from 2007 to 2014 was conducted to assess for ED visits or unplanned hospitalization within 30 days after surgery. Uni- and multivariate analyses were used to identify risk factors for ED visits and hospitalization.
  
  
  RESULTS
  Of 864 patients who underwent thyroidectomy (n = 673) or parathyroidectomy (n = 191), 96 (11.1 %) had an ED visit and 41 (4.7 %) were hospitalized within 30 days after surgery. Univariate analysis showed hypocalcemia (p = 0.001), younger age (p = 0.02), total thyroidectomy (p = 0.01), and lack of private health insurance (p = 0.005) to be predictive of an ED visit and hypocalcemia (p = 0.0001), Hashimoto's thyroiditis (p = 0.049), total thyroidectomy (p = 0.005), and African American race (p = 0.03) were predictive of hospitalization after thyroidectomy. Multivariate analysis showed younger age (odds ratio [OR] 1.5 per 10-year decrease in age; p = 0.002; 95 % confidence interval [CI] 1.1-1.8) and Medicare insurance (OR 2.7; p = 0.01; 95 % CI 1.3-5.7) to be independently associated with an ED visit, and hypocalcemia (OR 4.7; p < 0.001; 95 % CI 2.2-11.0) was the only independent factor associated with hospitalization after thyroidectomy. Univariate analysis showed hypocalcemia, renal hyperparathyroidism, and multiglandular disease to be predictive of an ED visit and hospitalization after parathyroidectomy. The sample size for parathyroidectomy was too small for multivariate analysis.
  
  
  CONCLUSIONS
  Targeted strategies for transitions of care for patients with postoperative hypocalcemia may help to reduce ED visits and hospitalization after thyroidectomy and parathyroidectomy.
authors.affiliation: Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Ryan A
authors.initials: RA
authors.lastname: FitzGerald
authors.affiliation: Department of Medicine, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.|Rammelkamp Center for Research, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.|Center for Reducing Health Disparities, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Ashwini R
authors.initials: AR
authors.lastname: Sehgal
authors.affiliation: Rammelkamp Center for Research, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Nichols
authors.affiliation: Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA. cmchenry@metrohealth.org.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: McHenry
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009819:Office Visits / Q000706:statistics & numerical data*; D010282:Parathyroid Neoplasms / Q000473:pathology / Q000601:surgery; D016105:Parathyroidectomy / Q000009:adverse effects*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects*