Risk Factors for Prolonged Length of Stay and Readmission After Parathyroidectomy for Renal Secondary Hyperparathyroidism

• DOI: 10.1007/s00268-020-05711-y
• Publication Date: 2020-07-31T14:02:46Z
• Authors: Dessislava Stefanova; Timothy M. Ullmann; Jessica Limberg; Maureen Moore; Toni Beninato; Rasa Zarnegar; Thomas J. Fahey; Brendan M. Finnerty
• Keywords: Adult; Male; Parathyroidectomy; Length of Stay; Middle Aged; Patient Readmission; 3. Good health; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; Risk Factors; Humans; Female; Hyperparathyroidism, Secondary; Renal Insufficiency; Retrospective Studies

AbstractBackgroundPopulation‐based analyses of 30‐day outcomes after parathyroidectomy for renal secondary hyperparathyroidism are limited. We sought to identify risk factors associated with prolonged length of stay (LOS) and readmission in this patient population.MethodsPatients with secondary hyperparathyroidism who underwent parathyroidectomy were reviewed in the ACS‐NSQIP database (2011–2016). Patients were identified by ICD codes specific to secondary hyperparathyroidism of renal origin and the ACS‐NSQIP variable for current preoperative dialysis. Multivariable logistic regression was used to identify independent factors associated with prolonged LOS and 30‐day readmission after parathyroidectomy.ResultsThe cohort included 1846 patients with secondary hyperparathyroidism on dialysis who underwent parathyroidectomy. There were 416 (22.5%) patients classified under the prolonged LOS group. On multivariable analysis, factors associated with prolonged LOS included elevated preoperative alkaline phosphatase [OR 3.13 (95%‐CI 2.09–4.70), p < 0.001], decreased preoperative hematocrit [OR 1.83 (95%‐CI 1.25–2.68), p = 0.002], unplanned reoperation (OR 5.02 [95%‐CI 2.22–11.3], p < 0.001) and any postoperative complication [OR 6.12 (95%‐CI 3.31–11.3), p < 0.001]. The overall 30‐day readmission rate was 15.0%. Hypocalcemia and hungry bone syndrome accounted for 47.0% (n = 93/198) of readmissions. On multivariable analysis, patients with a history of hypertension and those undergoing unplanned reoperation were at risk of readmission [2.16 (95%‐CI 1.21–3.87), p = 0.009, and 2.40 (95%‐CI 1.15–5.02), p = 0.020, respectively], whereas reoperative parathyroidectomy was inversely associated with readmission (OR 0.24, 95%‐CI 0.07–0.80, p = 0.021).ConclusionIn patients undergoing parathyroidectomy for renal secondary hyperparathyroidism, several readily available preoperative biochemical markers, including those of increased bone turnover and anemia, are associated with prolonged postoperative LOS. Unplanned reoperation was predictive of both increased LOS and readmission.