MedicalResearch.com Interview with:
Raymond L. Chai, MD
Assistant Professor of Otolaryngology
Icahn School of Medicine at Mount Sinai.
MedicalResearch.com: What is the background for this study?
Response: Primary hyperparathyroidism is a common endocrine disorder affecting up to 1% of the general population. Surgical intervention is the only known durable cure for the disease. Untreated primary hyperparathyroidism can lead to number of health problems, including progressive osteoporosis and kidney stones. Although parathyroidectomy is a commonly performed surgical procedure by otolaryngologists, limited data exists regarding risk factors and rates of reoperation and readmission following surgery.
MedicalResearch.com: What are the main findings?
Response: Our study utilized data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), a prospectively maintained national database including over 400 hospitals. Of the roughly 10,000 patients meeting criteria for the study, 0.9% of patients required reoperation within 30 days of the index surgery while 2.1% of patients were readmitted to the hospital within 30 days of surgery. Major risk factors on multivariate analysis for reoperation include insulin-dependent diabetes, dialysis dependence, bleeding disorders, and chronic steroid usage. Major risk factors on multivariate analysis for readmission include increased operative time, dialysis dependence, and insulin-dependent diabetes. Each additional hour in the operating room conferred a roughly 20% increased risk for hospital readmission. Finally, re-exploration for persistent primary hyperparathyroidism after initial failed surgery was marginally significant for readmission.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Reoperation and readmission are uncommon after parathyroidectomy. However, for patients with diabetes, bleeding disorders, chronic steroid usage, and dialysis dependence, early and aggressive perioperative intervention should be considered.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Potential future studies include stratifying rates of readmission and reoperation for parathyroidectomy by surgeon experience, travel distance, hospital type (i.e. academic versus community program), hospital volume and insurance status to identify additional factors that affect quality metrics for this surgery.
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Presentation at the 2017 AAO-HNSF Annual Meeting & OTO Experience
Reoperation and Readmission after Parathyroidectomy
Ansley M. Roche, MD (presenter); Jason Brant, MD; Raymond L. Chai, MD
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