title: Evaluating the Incidence, Cause, and Risk Factors for Unplanned 30-Day Readmission and Emergency Department/General Practitioner Visit After Short-Stay Thyroidectomy.
abstract: BACKGROUND
  Unplanned 30-day readmission and emergency department (ED)/general practitioner (GP) visit after thyroidectomy are important healthcare quality measures and may reduce any cost savings from performing it as a short-stay (<24-h admission) procedure. Our study aimed to examine the incidence, cause, and risk factors for unplanned 30-day readmissions and ED/GP visits together following short-stay thyroidectomy.
  
  
  METHODS
  One-thousand and four patients who underwent short-stay thyroidectomy were reviewed. A territory-wide electronic medical record system was used to capture all unplanned readmissions and ED/GP visits within 30 days of thyroidectomy. Actual date and reason for readmission or ED/GP visit were recorded. Other preoperative and perioperative variables were collected prospectively.
  
  
  RESULTS
  Of the 80 (8.0 %) unplanned readmissions and ED/GP visits, 38 (47.5 %) were readmissions and 42 (52.5 %) were ED/GP visits only. The three most common causes of unplanned readmission and ED/GP visit were symptomatic hypocalcemia (n = 20, 25.0 %), upper respiratory symptoms (n = 15, 18.8 %), and wound complaints (n = 8, 10.0 %). However, in the multivariate analysis, only American Society of Anesthesiologists (ASA) class III (β coefficient = 0.981, odds ratio 2.586 (95 % CI 1.353-4.943), p = 0.004) and renal insufficiency (RI) (β coefficient = 1.062, odds ratio 2.892 (95 % CI 1.109-7.544), p = 0.030) were independent risk factors for unplanned 30-day readmission and ED/GP visit.
  
  
  CONCLUSIONS
  The overall incidence of unplanned 30-day ED/GP visit after thyroidectomy was 8.0 % with approximately half requiring readmission. The most common cause for unplanned ED/GP visit was symptomatic hypocalcemia (25.0 %), and it was attributed to patient non-compliance to prescribed supplements. ASA class III and RI were significant independent risk factors for unplanned 30-day readmission and ED/GP visit.
authors: Division of Endocrine Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China. blang@hku.hk.
authors: Brian Hung-Hin
authors: BH
authors: Lang
authors: Division of Endocrine Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China.
authors: Felix Che-Lok
authors: FC
authors: Chow
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D051437:Renal Insufficiency / Q000209:etiology; D012140:Respiratory Tract Diseases / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013965:Thyroidectomy / Q000009:adverse effects*