Hypothyroidism Prolongs Hospitalization Following Surgery

Abstract

Objective: Each year 45 million surgical procedures are performed in the United States, and a significant number of these are performed on hypothyroid patients. Little guidance is available to determine the postoperative risk to these subjects. We hypothesized that new surgical techniques and modern anesthesia would lead to no differences in outcome between hypothyroid patients and euthyroid controls. Methods: We queried surgical databases in our health system for patients who underwent an operative procedure between January 1, 2010 and December 31, 2015 with a TSH > 10 mcU/mL or a FT4 < 0.6 ng/dL. Identified patients were matched to euthyroid controls selected for age, sex, surgical procedure, and search interval. Predicted length of hospital stay (LOS) was determined using the American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator. Results: We identified 29 hypothyroid patients. The LOS was significantly longer for the hypothyroid patients compared to the predicted LOS (14.4 vs 6.7 days, P < 0.001). The LOS in the matched controls was not significantly different than their predicted LOS (9.6 vs 7.1 days, P = 0.11). Other complications were not different between the hypothyroid and control patients. Conclusions: In contrast to our initial hypothesis, hypothyroidism is associated with a 2-fold longer LOS following surgery. Hypothyroidism continues to place patients at increased surgical risk.

Is thyroid disease associated with post-operative complications after total joint arthroplasty? A systematic review of the literature

“…A recent study reported a significantly longer postoperative length of hospital stay (LOS) for hypothyroid patients compared to the predicted LOS determined using a surgical risk calculator ( 22 ). Hypothyroid patients had a trend toward a higher incidence of ileus, use of vasopressors, and need for reintubation but equal rates of chronic obstructive pulmonary disease and a lower incidence of obstructive sleep apnea than euthyroid controls ( 23 ).…”

“…Hypothyroidism is strongly associated with an increased risk of postoperative myocardial dysfunction, atrial fibrillation, and risk of death in patients undergoing cardiac surgery ( 23 , 24 , 25 , 26 ). However, Komatsu et al found no association of hypothyroidism with LOS or other complications in patients after cardiac surgery ( 24 ).…”