Objectives
To describe the subset of patients requiring emergency room (ER) evaluation within 30 days of their thyroidectomy or parathyroidectomy and their associated risk factors.

Study design
Retrospective chart review

Methods
Patients undergoing thyroidectomy or parathyroidectomy between 1/1/2009 and 10/7/2010 were identified via the IRB approved thyroid/parathyroid database. Postoperative patients who visited the ER within the first 30 days following surgery were selected. Univariate two-group t-tests, Wilcoxon Mann-Whitney tests, and chi-square tests were used to evaluate 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 ER visit based on presence of diabetes or proton pump inhibitor usage. Odds ratios and 95% confidence intervals were considered significant at p < 0.05.

Results
Of the 571 patients who underwent 652 thyroidectomy or parathyroidectomy surgeries between 1/1/2009 and 10/7/2010, 62 patients required a visit to the emergency room within our tertiary medial care system a total of 77 times for issues including paresthesias (n=28), wound complications (n=9), and weakness (n=7). Out of these emergency room evaluations, 14 hospital admissions occurred for treatment of a variety of post operative complications. There were no significant age, gender, race, or body mass index differences between the two groups. A significant association was found between the presence of diabetes (p=0.043) and the current use of proton pump inhibitors (p=0.028). When controlling for diabetes, patients taking PPIs were 1.71 times more likely to visit the emergency room than patients not on proton pump inhibitors (p-0.045).

Conclusions
Postoperative complications from thyroidectomy and parathyroidectomy requiring
ER evaluation are significant. Postoperative patients taking proton pump inhibitors were more likely to visit the ER than patients not on PPIs. Changes in calcium absorption with PPI usage has been documented and attributed to lower bioavailablity of oral calcium in the higher gastric pH environment. Reduced calcium absorption of patients undergoing PPI therapy may be the associated with higher ER evaluation rates following thyroidectomy or parathyroidectomy.