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Original Investigation |

Causes of Emergency Department Visits Following Thyroid and Parathyroid Surgery

William G. Young, MD1; Eric Succar, BS2; Linda Hsu, BS2; Gary Talpos, MD3; Tamer A. Ghanem, MD, PhD1
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan
2Wayne State Medical School, Detroit, Michigan
3Department of General Surgery, Henry Ford Health System, Detroit, Michigan
JAMA Otolaryngol Head Neck Surg. 2013;139(11):1175-1180. doi:10.1001/jamaoto.2013.4505.
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Importance  With reimbursement being increasingly tied to outcome measures, minimizing unexpected health care needs in the postoperative period is essential. This article describes reasons for emergency department (ED) evaluation, rates of readmission to the hospital, and significant risk factors for readmission during the postoperative period.

Objective  To describe the subset of patients requiring ED evaluation within 30 days of thyroidectomy or parathyroidectomy and their associated risk factors.

Design, Setting, and Patients  Retrospective chart review in a tertiary care center of adult patients who underwent thyroidectomy or parathyroidectomy between January 1, 2009 and October 7, 2010. Patients were identified from an institutional review board–approved database. Postoperative patients who visited the emergency department (ED) within the first 30 days following surgery were selected and compared with the postoperative patients who did not visit the ED.

Exposures  Thyroidectomy or parathyroidectomy.

Main Outcomes and Measures  Statistical analysis evaluated the association of demographic and clinical characteristics between the patients who required ER evaluation and those who did not. Clinical characteristics evaluated included type of surgery, medical comorbidities, and proton pump inhibitor (PPI) usage. Multiple logistic regression predicted the odds of an ED visit based on presence of diabetes, gastroesophageal reflux disease (GERD), or PPI use.

Results  Of the 570 patients identified, 64 patients required a visit to the ER a total of 75 times for issues including paresthesias (n = 28), wound complications (n = 8), and weakness (n = 6). Fifteen hospital admissions occurred for treatment of a variety of postoperative complications. A significant association was found between the presence of diabetes (P = .03), GERD (P = .04), and the current use of PPIs (P = .03). When controlling for diabetes and GERD, we found that patients taking PPIs were 1.81 times more likely to visit the ED than patients not taking PPIs (P = .04).

Conclusions and Relevance  Patients taking PPIs are 1.81 times more likely to require ED evaluation than those who are not taking PPIs.

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Figure.
Kaplan-Meier Curves for Time to Emergency Department (ED) Visit in Postoperative Days for Patients Presenting to the ED With Paresthesias vs No Paresthesias

Patients experiencing paresthesias presented to the ED for evaluation sooner than those who did not experience paresthesias.

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