Time to Hypothyroidism Following Hemithyroidectomy.

Background The time to hypothyroidism post hemithyroidectomy is variable. There are multiple risk factors for developing hypothyroidism. The aim of this study was to identify the time of hypothyroidism and other predictors of hypothyroidism in euthyroid patients following hemithyroidectomy. Methods This was a retrospective study. Of 170 euthyroid patients who underwent hemithyroidectomy for benign disease between 2006 - 2014, age, gender, pre-operative thyroid function tests, body mass index (BMI), and other co-morbidities were examined to determine predictors of early (<3 months) or late (>3 months) hypothyroidism. A high normal preoperative thyroid stimulating hormone (HN-TSH) was defined as ≥2.01 uIU/ml, and a low normal TSH (LN-TSH) was defined as <2.01 uIU/ml. Results A total of 63 of the 170 patients (37%) became hypothyroid. At 3 months, 21.5% of patients were hypothyroid. At 6 months after operation, an additional 5% had become hypothyroid, and after 1 year, 8% more were hypothyroid. The only independent predictor of hypothyroidism was preoperative HN-TSH (≥2.01) (p<0.001) on multivariate analysis. Conclusion In addition to known predictors of hypothyroidism following hemithyroidectomy for benign disease, such as the size of the thyroid remnant, a history of neck irradiation, and coexisting thyroid autoimmune disease, a BMI ≥35 kg/m2, age ≥45, and preoperative HN-TSH are risk factors for postoperative hypothyroidism within 3 months of operation. Such patients should be closely monitored.

Predictors of Hospital Readmission after Bariatric Surgery.

BACKGROUND: Identification of factors that might predict readmission after bariatric surgery could help surgeons target high-risk patients. The purpose of this study was to identify comorbidities, surgical variables, and postoperative complications associated with readmission. STUDY DESIGN: Patients with bariatric surgery as their primary procedure were identified from the 2012 American College of Surgeons (ACS) NSQIP database. Patient variables, operative times, and major postoperative complications were analyzed for predictors of readmission. The ACS NSQIP estimated probability of morbidity (MORBPROB) was also considered. Chi-square tests and Poisson regression were used for statistical analysis to identify significant predictors. RESULTS: There were 18,186 patients who met inclusion criteria. There were 1,819 who had a laparoscopic gastric band, 9,613 who had laparoscopic Roux-en-Y gastric bypass (RYGB), 6,439 who had gastroplasties (vertical banded gastroplasty and sleeve), and 315 who had open RYGB. Age, sex, BMI, American Society of Anesthesiologists (ASA) class, diabetes, hypertension, steroid use, type of procedure, and operative time all were significantly associated with readmission within 30 days of operation. All major postoperative complications were significant predictors of readmission. Patients expected to be at high risk based on the ACS NSQIP MORBPROB had a significantly higher rate of readmissions. The overall readmission rate for patients undergoing bariatric surgery was 5%. The readmission rate among patients with any major complication was 31%. CONCLUSIONS: Bariatric surgery is a low-risk procedure. Complexity of operation, ASA class, prolonged operative time, and major postoperative complications are important determinants of high risk for readmission. The ACS NSQIP MORBPROB may be a useful tool to identify and target patients at risk for readmission.

A NSQIP risk assessment for thyroid surgery based on comorbidities.

BACKGROUND: Thyroid surgery is associated with low mortality and morbidity and often is performed in an ambulatory setting. The majority of patients undergoing thyroidectomy have an uncomplicated outcome, but common comorbidities may increase mortality and morbidity. Due to low complication rates, studies using single surgeon or single institutional data to identify risk factors for adverse outcomes may be limited by inadequate patient volume. STUDY DESIGN: This retrospective cohort study used data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). The study group included all thyroidectomy patients over a 6-year period (2005 to 2010). Common patient comorbidities were identified and analyzed using logistic regression. Risk of adverse outcomes was calculated for single and multiple comorbidities. Statistical significance was set at p < 0.05. RESULTS: The study group included 38,577 consecutive patients. Thirty-day mortality and postoperative morbidity were 0.06% and 1.49%, respectively. The risk factors independently associated with morbidity included hypertension, diabetes, advanced age greater than 70 years, COPD, dialysis, malignant thyroid disease, and surgical approach (total thyroidectomy). Substernal thyroidectomy, hypertension, diabetes, age greater than 70 years, COPD, and dialysis were significant predictors (unadjusted) of mortality. Multiple comorbidities resulted in significant cumulative risk. The presence of 3 or more comorbidities was associated with a postoperative morbidity of 5.1% (p < 0.001) and mortality as high as 12.5%. CONCLUSIONS: Thyroid surgery is generally safe. Common comorbidities significantly increase the risk of adverse outcomes and death. Clinically applicable risk calculation based on overall health may improve patient selection, surgical management, and informed consent.