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American Head & Neck Society
Annual Meeting, April 10-11, 2013
JW Marriott Grande Lakes
Orlando, Florida

During the
Combined Otolaryngology Spring Meeting
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ANALYSIS OF READMISSIONS AFTER THYROIDECTOMY AND PARATHYROIDECTOMY ? DOES PPI THERAPY INCREASE RISK OF READMISSION SECONDARY TO POSTOPERATIVE HYPOCALCEMIA

Presentation: P050
Topic: Clinical - Gen. Head & Neck Surgery
Type: Poster
Date: Wednesday - Thursday, April 10 - 11, 2013
Session: Designated Poster viewing times
Authors: Narges Mazloom, DO, Tamer A Ghanem, MD, PhD, Francis T Hall, MD, Kathleen L Yaremchuk, MD
Institution(s): Department of Otolaryngology, Head and Neck Surgery, Henry Ford Hospital, Detroit, MI

OBJECTIVE: Causes and risk factors for hospital readmissions following thyroidectomy and parathyroidectomy are not well reported. In this study we not only aim to identify procedure and patient-specific risk factors affecting readmission, but we also investigate the possible role of PPI therapy in the increased risk of hypocalcemia related readmissions.


METHOD: Retrospective chart review of all patient who had undergone thyroid or parathyroid surgery between 1/1/2009 and 2/4/2011 at a tertiary care academic hospital by multi-specialty surgeons. 


RESULTS: A total of 633 unique patients, mean age of 56, and 80% females underwent a total of 642 surgeries including total thyroidectomy, thyroid lobectomy, parathyroidectomy, or thyroidectomy with concurrent parathyroidectomy. There were 18 (2.8%) unplanned readmissions within thirty (30) days of a procedure. Readmissions were secondary to hypocalcemia (50%), hematoma/neck abcess (11%), and other causes (39%). Risk for readmission was statistically significant for patients who had undergone a central neck dissection (p= 0.005), those with underlying ESRD (p=0.012), and those on PPI therapy (p=0.015). Of the patients readmitted for hypocalcemia, statistically significant risk factors included central neck dissection (p=0.003) and PPI therapy (p=0.006), but not ESRD (p=1.000).


CONCLUSION: Studies have shown a significantly increased risk of osteoporosis-related fractures with prolonged PPI use due to their postulated impairment of intestinal calcium absorption. Therefore, the concurrent use of a PPI especially during the crucial postoperative period when calcium homeostasis in stressed due to impaired parathyroid function, may exacerbate hypocalcemia. In our study hypocalcemia was the most common cause of unplanned postoperative readmission. Our findings show that postoperative PPI therapy increases the risk of hypocalcemia related unplanned readmissions post thyroid and parathyroid surgery.
 

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