COMMENTARY

Readmissions After Thyroid Surgery: Pay Close Attention to Calcium Levels

Albert B. Lowenfels, MD

Disclosures

April 25, 2019

How frequently do readmissions occur after thyroid surgery? In a recent paper published in Surgery,[1] the authors documented the frequency and causes of readmission following thyroid surgery in 22,654 patients based on data contained in the 2014 Nationwide Readmissions Database. A total of 990 patients were readmitted, yielding an overall 30-day readmission rate of 4.4%. Slightly more than half of all patients were readmitted in the first postoperative week.

The most common causes for readmission were disturbances of mineral metabolism and hypocalcemia, whereas the type of procedure and the underlying diagnosis were not associated with readmission. The major factors increasing the risk of readmission were:

  • Medicare or Medicaid insurance,

  • Discharge to inpatient postacute care, and/or

  • Initial hospital stay of 2 or more days.

Monitor Calcium Levels

The 30-day hospital readmission rate is increasingly relied upon as a metric for patient care quality and has an influence on reimbursement.[2] This comprehensive report indicates that the 30-day readmission rate following thyroid surgery, at 4.4%, is reasonable, especially when compared with readmission rates for other types of surgery, such as colon surgery, which are about 11%.[1,3]

Some of the risk factors found to be associated with readmission after thyroid surgery, such as type of insurance coverage, are not modifiable. However, paying closer attention to patients' calcium levels prior to discharge and providing them with information about symptoms of altered calcium levels might lead to earlier recognition of this complication and potentially reduce the readmission rate.

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