Advertisement

World Journal of Surgery

, Volume 43, Issue 2, pp 534–539 | Cite as

Risk Factors for Readmission After Parathyroidectomy for Renal Hyperparathyroidism

  • Justin D. Lee
  • Eric J. Kuo
  • Lin Du
  • Michael W. Yeh
  • Masha J. Livhits
Original Scientific Report (including Papers Presented at Surgical Conferences)

Abstract

Background

Patients with renal hyperparathyroidism (RHPT) are susceptible to major electrolyte fluctuations following parathyroidectomy, which may predispose them to early readmission. The purpose of this study is to evaluate risk factors for readmission in patients undergoing parathyroidectomy for RHPT.

Methods

Patients with renal failure who underwent parathyroidectomy were abstracted from the California Office of Statewide Health Planning and Development (1999–2012). Multivariable logistic regression was used to identify risk factors for readmission within 30 days of discharge.

Results

The cohort included 4411 patients, of whom 17% were readmitted. Procedures included subtotal parathyroidectomy (74% of cases) and total parathyroidectomy with autotransplantation (26%). Median time to readmission was 9 days (interquartile range 4–16 days). Electrolyte disturbances including hypocalcemia were present in 36% of readmissions and were the most common cause for readmission. Independent risk factors for readmission included Black race [odds ratio (OR) 1.26, 95% confidence interval (CI) 1.00–1.57], Hispanic race (OR 1.38, 95% CI 1.12–1.71), disposition with home health (OR 1.94, 95% CI 1.35–2.77), disposition to a skilled nursing facility (OR 2.30, 95% CI 1.58–3.35), and total parathyroidectomy with autotransplantation (OR 1.27, 95% CI 1.06–1.52). Advancing age (OR 0.98, 95% CI 0.98–0.99) and surgery at a high-volume hospital (OR 0.53, 95% CI 0.36–0.77) were protective against readmission.

Conclusions

Patients undergoing parathyroidectomy for RHPT have a high readmission rate, most frequently for metabolic complications. Increased postoperative vigilance, which may include outpatient laboratory monitoring, may be indicated in patients with risk factors for readmission.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

268_2018_4823_MOESM1_ESM.docx (25 kb)
Supplementary material 1 (DOCX 24 kb)

References

  1. 1.
    Hedgeman E et al (2015) International Burden of chronic kidney disease and secondary hyperparathyroidism: a systematic review of the literature and available data. Int J Nephrol 2015:1–15CrossRefGoogle Scholar
  2. 2.
    Cannata-Andía JB, Carrera F (2008) The pathophysiology of secondary hyperparathyroidism and the consequences of uncontrolled mineral metabolism in chronic kidney disease: the role of COSMOS. NDT Plus 1:i2–i6Google Scholar
  3. 3.
    Sharma J et al (2012) Improved long-term survival of dialysis patients after near-total parathyroidectomy. J Am Coll Surg 214:400–407 (discussion 407–408) CrossRefGoogle Scholar
  4. 4.
    Ishani A et al (2015) Clinical outcomes after parathyroidectomy in a nationwide cohort of patients on hemodialysis. Clin J Am Soc Nephrol CJASN 10:90–97CrossRefGoogle Scholar
  5. 5.
    Kuo LE, Wachtel H, Karakousis G, Fraker D, Kelz R (2014) Parathyroidectomy in dialysis patients. J Surg Res 190:554–558CrossRefGoogle Scholar
  6. 6.
    Anderson K et al (2017) Subtotal vs. total parathyroidectomy with autotransplantation for patients with renal hyperparathyroidism have similar outcomes. Am J Surg.  https://doi.org/10.1016/j.amjsurg.2017.07.018 Google Scholar
  7. 7.
    Thomas LE, Pencina MJ (2016) Do not over (P) value your research article. JAMA Cardiol 1:1055CrossRefGoogle Scholar
  8. 8.
    Mullen MG et al (2014) Risk factors for 30-day hospital readmission after thyroidectomy and parathyroidectomy in the United States: an analysis of National Surgical Quality Improvement Program outcomes. Surgery 156:1423–1430 (discussion 1430–1431) CrossRefGoogle Scholar
  9. 9.
    Cunningham J, Locatelli F, Rodriguez M (2011) Secondary hyperparathyroidism: pathogenesis, disease progression, and therapeutic options. Clin J Am Soc Nephrol CJASN 6:913–921CrossRefGoogle Scholar
  10. 10.
    Jofre R et al (2003) Parathyroidectomy: whom and when? Kidney Int 63(Suppl 85):S97–S100.  https://doi.org/10.1046/j.1523-1755.63.s85.23.x CrossRefGoogle Scholar
  11. 11.
    Brasier AR, Nussbaum SR (1988) Hungry bone syndrome: clinical and biochemical predictors of its occurrence after parathyroid surgery. Am J Med 84:654–660CrossRefGoogle Scholar
  12. 12.
    Tsai TC, Joynt KE, Orav EJ, Gawande AA, Jha AK (2013) Variation in surgical-readmission rates and quality of hospital care. N Engl J Med 369:1134–1142CrossRefGoogle Scholar
  13. 13.
    Mor V, Intrator O, Feng Z, Grabowski DC (2010) The revolving door of rehospitalization from skilled nursing facilities. Health Aff 29:57–64CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Justin D. Lee
    • 1
  • Eric J. Kuo
    • 1
  • Lin Du
    • 2
  • Michael W. Yeh
    • 1
  • Masha J. Livhits
    • 1
  1. 1.Section of Endocrine SurgeryUCLA David Geffen School of MedicineLos AngelesUSA
  2. 2.Department of BiomathematicsUCLA David Geffen School of MedicineLos AngelesUSA

Personalised recommendations