Annals of Surgical Oncology

, Volume 22, Issue 2, pp 429–436 | Cite as

Assessing Safety and Outcomes in Outpatient versus Inpatient Thyroidectomy using the NSQIP: A Propensity Score Matched Analysis of 16,370 Patients

  • Nima Khavanin
  • Alexei Mlodinow
  • John Y. S. Kim
  • Jon P. Ver Halen
  • Anuja K. Antony
  • Sandeep Samant
Endocrine Tumors

Abstract

Background

With increasing economic healthcare constraints and an evolving understanding of patient selection criteria and patient safety, outpatient thyroidectomy is now more frequently employed. However, robust statistical analyses evaluating outcomes and safety after outpatient thyroidectomy with matched comparisons to inpatient cohorts are lacking.

Methods

The 2011-2012 NSQIP datasets were queried to identify all patients undergoing thyroidectomy. Inpatient and outpatient procedures cohorts were matched 1:1 using propensity score analysis to assess outcomes. Outcomes of interest included surgical and medical complications, reoperation, mortality, and readmission. Univariate and multivariate analyses were utilized to identify predictors of these events. Relative risk ratios were calculated for adverse events between inpatient and outpatient cohorts.

Results

In total, 21,508 patients were identified to have undergone a thyroidectomy in 2011–2012. Inpatients and outpatients were matched 1:1 with respect to preoperative and operative characteristics, leaving 8,185 patients in each treatment arm. After matching, overall 30-day morbidity was rare with only 250 patients (1.53 %) experiencing any perioperative morbidity. 476 patients (2.91 %) were readmitted within 30-days of the operation. Both pre- and post-matching, inpatient thyroidectomy was associated with increased risks of readmission, reoperation, and any complication.

Conclusions

Based on this comprehensive population-based study, outpatient thyroidectomy appears to be at least as safe as inpatient thyroidectomy. However, there are still differences in outcomes between inpatient and outpatient cohorts, despite statistical matching of preoperative and intraoperative variables. Future research needs to be spent identifying these as-of-yet unknown risk factors to resolve this discrepancy.

Notes

Financial Support

This particular research received no internal or external grant funding.

Conflict of interest

The authors report no relevant financial disclosures related to this current work.

Ethical Approval

De-identified patient information is freely available to all institutional members who comply with the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Data Use Agreement. The Data Use Agreement implements the protections afforded by the Health Insurance Portability and Accountability Act of 1996.

Disclaimer

The NSQIP and the hospitals participating in the NSQIP are the source of the data used herein; they have not been verified and are not responsible for the statistical validity of the data analysis, or the conclusions derived by the authors of this study.

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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Nima Khavanin
    • 1
  • Alexei Mlodinow
    • 1
  • John Y. S. Kim
    • 1
  • Jon P. Ver Halen
    • 2
  • Anuja K. Antony
    • 3
  • Sandeep Samant
    • 4
  1. 1.Division of Plastic and Reconstructive SurgeryNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Division of Plastic and Reconstructive SurgeryBaptist Cancer Center-Vanderbilt Ingram Cancer CenterMemphisUSA
  3. 3.Division of Plastic and Reconstructive SurgeryUniversity of Illinois at ChicagoChicagoUSA
  4. 4.Department of Otolaryngology-Head and Neck SurgeryUniversity of Tennessee Health Science CenterMemphisUSA

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