Complications after Thyroidectomy and

Parathyroidectomy at Teaching Hospitals: A

Nationwide Inpatient Sample Analysis

 The surgical residency training model

of graduated responsibility leads to
the perception amongst health
professionals and the public at large
that there may be a greater risk of
complications for patients treated at
academic teaching hospitals.

 For surgeries performed at teaching hospitals,

there is also the perception that care received
at the beginning of the academic year more
hazardous
As newly graduated physicians begin their
training, and as junior residents assume new,
more senior roles, they may not have the
experience necessary to prevent patient
complications. public perception that
academic hospitals are dangerous near the
beginning of the academic year

 Thyroidectomy and
parathyroidectomy are among the
most commonly performed general
surgery procedures, and are
considered to be relatively safe.

Material and Metods

The Nationwide Inpatient Sample
(NIS), administered by the
Healthcare Cost and Utilization
Project (HCUP) and is a large national
database that collects data on all
patients discharged from a sample of
approximately 1000 U.S. hospitals
each year, which represents
approximately 20% of all hospital
discharges in a given year

 All patients in the 2010 NIS database

undergoing thyroidectomy or
parathyroidectomy were divided into
two cohorts based on whether the
procedure was performed at an
academic teaching hospital for
further comparative analysis

 statistical analyses STATA version 12

Bivariate analysis on cohorts was done using
Students t-test.
categorical variables 2 analysis
The primary dependent variables of interest
were total complications, bleeding
complications, vocal cord paralysis, and
hypocalcemia.
Secondary dependent variables included
length of stay and total charges.

 Multiple logistic regression models

for the dependent variables of
interest were created using hospital
teaching status, patient
comorbidities, payer source, elective
vs. emergent admission, race, sex,
and age. A significance level of
0.05% was considered significant for
all tests.

RESULT
In 2010, an estimated 76,725 patients
underwent thyroidectomy or
parathyroidectomy in the U.S
15,720 patients were captured by the NIS
database and were included in the analysis
Thyroidectomy 85.8% of patients,
parathyroidectomy 18.5%.
The most common surgery performed was
total thyroidectomy

 Concomitant laryngectomy (0.6%)

neck dissection was more common
(5.6%).
Female 77.5% mean age was
53.5 years
The average length of stay (LOS) was
2.5 days, while the mean total
hospital charges were $33,903.67.

 In this study, we found that complication rates

after thyroidectomy and parathyroidectomy are
comparable when performed at teaching and
non-teaching hospitals.
a lower risk of complications at teaching
hospitals
The most feared complications of these
procedures include bleeding, hypocalcemia
secondary to inadvertent removal or injury to
the parathyroid glands, and vocal cord paralysis
due to recurrent laryngeal nerve injury.

 the only one found to have higher

rates at teaching hospitals was vocal
cord paralysis this increase was
relatively small, and is likely to be of
little clinical significance

 In conclusion, thyroidectomy and

parathyroidectomy is safe overall. Complications
are similar whether the procedures are
performed at teaching hospitals or non-teaching
hospitals. Thus, these procedures can be safely
performed at teaching hospitals. The results
presented here can help to dispel the myth that
there is a July effect for complications at
teaching hospitals. Surgeons can use these data
to assure their patients of the low risk associated
with thyroidectomy and parathyroidectomy