Systematic Review and Meta-analysis of Unplanned Reoperations, Emergency Department Visits, and Hospital Readmission After Thyroidectomy.

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Systematic Review and Meta-analysis of Unplanned Reoperations, Emergency Department Visits, and Hospital Readmission After Thyroidectomy.

Thyroid. 2018 Mar 27;:

Authors: Margolick J, Chen W, Wiseman S

Abstract
BACKGROUND: Unplanned reoperation, Emergency Department (ED) visits, and hospital readmission following thyroid operations usually arise due to complications, and are a source of frustration for both surgeons and patients. With an aim to provide insight important for the development of patient quality care improvement initiatives, the primary objective of this review was to systematically evaluate the available literature in order to determine the contemporary rates of reoperation, readmission and ED visits following thyroid operations. A secondary study objective was to determine if there were any practices that showed promise in reducing the occurrence of these undesirable post-operative events.
METHODS: This systematic review was conducted in accordance with the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses protocols (PRISMA-P). Twenty-two studies were included in the systematic review. Meta-analysis was performed to obtain the weighted-pooled summary estimates of rates of reoperations, ED visits and unplanned hospital readmission. Jackknife sensitivity analyses was performed for each dataset. Finally, in order to detect the risk of publication bias and the small-study effect, funnel plot analysis was performed.
RESULTS: The pooled rate estimate for reoperation was very low (0.6% [95% CI: 0.3─1.1%]). This was subject to publication bias because small studies tended to report lower rates of reoperation. The pooled rate of ED visits was 8.1% (95% CI: 6.5% ─ 9.8%) while the pooled rate of hospital readmission from 19 studies was 2.7% (95% CI: 2.1─3.4%). Neck hematoma was the most common reason for reoperation while post-operative hypocalcemia was the most common reason for hospital readmission.
CONCLUSIONS: ED visits and hospital readmission after thyroidectomy are not uncommon and there are several practices that reduce their occurrence. Routine post-operative calcium and vitamin D supplementation may reduce rates of post-operative hypocalcemia, and avoiding post-operative hypertension may decrease the risk of neck hematoma and need for reoperation. Older age, thyroid cancer, dependent functional status, higher ASA score, diabetes, COPD, steroid use, hemodialysis and recent weight loss increase the risk of hospital readmission after thyroid surgery. By further identifying risk factors for reoperation, ED visits and readmission, this review may assist practitioners in optimizing perioperative care, and therefore reducing patient morbidity and mortality after thyroid operations.

PMID: 29587583 [PubMed - as supplied by publisher]

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