Unplanned 30‐Day Readmissions after Parathyroidectomy in Patients with Chronic Kidney Disease: A Nationwide Analysis

Abstract

Objective To examine rates of readmission after parathyroidectomy in chronic kidney disease patients and determine primary etiologies, timing, and risk factors for these unplanned readmissions. Study Design Retrospective cohort study Setting Nationwide Readmissions Database Subjects and Methods The Nationwide Readmissions Database was queried for parathyroidectomy procedures performed in chronic kidney disease patients between 1/2013 - 11/2013. Patient, admission, and hospital-level characteristics were compared for patients with and without at least one unplanned thirty-day readmission. Outcomes of interest included rates, etiology, and timing of readmission. Multivariate logistic regression was used to identify predictors of thirty-day readmission. Results There were 2756 parathyroidectomies performed in patients with chronic kidney disease with an unplanned readmission rate of 17.2%. Hypocalcemia/hungry bone syndrome accounted for 40% of readmissions. Readmissions occurred uniformly throughout the thirty days after discharge, however readmissions for hypocalcemia/hungry bone syndrome peaked in the first 10 days and decreased over time. Weight loss/malnutrition at time of parathyroidectomy and length of stay of 5-6 days conferred increased risk of readmission with adjusted odds ratios (aOR) of 3.31 (95% CI 1.55 – 7.05, P = 0.002) and 1.87 (95% CI 1.10 – 3.19, P = 0.02), respectively. Relative to primary hyperparathyroidism, parathyroidectomies performed for secondary hyperparathyroidism (aOR 2.53, 95% CI 1.07-5.95, P = 0.03) were associated with higher risk of readmission. Conclusion Post-parathyroidectomy readmission rates for chronic kidney disease patients are nearly 5-times that of the general population. Careful consideration of post-operative care and electrolyte management is crucial to minimize preventable readmissions in this vulnerable population.

Clinical and Economical Outcomes Associated with Parathyroidectomy: A 5-Year Population-Based Study in a Middle-Income Country with Universal Health Coverage

“…e most frequent indication is primary HPT (59.89%) by secretory adenoma, described in the general population, with some cases isolated in ERSD, the second indication of PTX is secondary HPT (21.9%), which is present in ERSD [7]. e PTX outcomes in dialysis patients are worse than in patients without CKD, and there is a higher probability of adverse events due to comorbidity: diabetes mellitus, hypertension, and heart failure [14]. Hospital readmissions and postparathyroidectomy mortality are 5 times more frequent than in the general population, with the subsequent impact on costs for health systems [7,14].…”

“…e PTX outcomes in dialysis patients are worse than in patients without CKD, and there is a higher probability of adverse events due to comorbidity: diabetes mellitus, hypertension, and heart failure [14]. Hospital readmissions and postparathyroidectomy mortality are 5 times more frequent than in the general population, with the subsequent impact on costs for health systems [7,14]. Kuo et al studied 898 dialysis patients and found 30-day readmission rates of 17.8%, [15].…”

“…At 1-year follow-up, hospitalizations increased by 39%, as well as the days spent in hospital, and the emergency room visits for hypocalcaemia were 20 times higher than in the year prior to surgery [16]. Ferrandino et al found 17.2% of readmissions, mainly due to hungry bone syndrome (40%), and found as risk factors for readmission, weight loss, and malnutrition at the time of surgery [14].…”

Severe Hypocalcemia after Total Parathyroidectomy Plus Autotransplantation for Secondary Hyperthyroidism-Risk Factors and a Clinical Algorithm

“…A total of 2756 parathyroidectomy procedures were performed in patients with CKD, with unplanned readmission rate of 17.2 and 6.8% due to hypocalcemia/ hungry bone syndrome. In one study, readmission occurred within 30 days after discharge, but readmission for severe hypocalcemia peaked within just 10 days and decreased thereafter [32].…”

Effectiveness of the Gamma Probe in Childhood Parathyroidectomy: Retrospective Study

“…It has been seen in the literature that the number of cases with parathyroidectomy due to secondary hyperparathyroidism in children and adolescents is low, and it is mostly performed by adult surgeons [12][13]. The experience of adult surgeons does not fully reflect the treatment and follow-up methods related to children.…”