CKD Patients Frequently Re-hospitalized After Parathyroidectomy

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Parathyroidectomy for hyperparathyroidism in CKD patients is associated with a 30-day readmission rate of 17.2%.
Parathyroidectomy for hyperparathyroidism in CKD patients is associated with a 30-day readmission rate of 17.2%.

In a recent study, 1 in 6 patients with chronic kidney disease (CKD) who underwent parathyroidectomy were readmitted to the hospital within 30 days of discharge.

Using the Nationwide Readmissions Database, investigators identified 2756 CKD patients who underwent total or subtotal parathyroidectomy (PTx) from January to November 2013. Of these, 50% underwent PTx for secondary hyperparathyroidism (SHPT), 22% for primary hyperparathyroidism, and 13.5% for unspecified hyperparathyroidism.

 

Of the 2756 patients, 17.2% were readmitted within 30 days of discharge, Marita S. Teng, MD, of the Icahn School of Medicine at Mount Sinai, and peers reported online ahead of print in Otolaryngology—Head and Neck Surgery. The top cause was hypocalcemia/hungry bone syndrome at 31.2%, in line with National Surgical Quality Improvement Program data (36%). In the present study, hypocalcemia readmissions peaked in the first 10 days, then subsided: 40% at 1 to 10 days, 28.3% at 11 to 20 days, and 25.1% at 21 to 30 days.

“Since hypocalcemia readmissions tend to occur more frequently in the early postoperative period, providers should consider earlier prescriptions of calcium/vitamin D supplements, either at the preoperative visit or at least 24 hours before discharge, allowing adequate time for patients to acquire these critical medications,” Dr Teng and the team suggested.

On multivariable analysis, predictors of post-PTx readmission included weight loss/malnutrition and initial hospital length of stay of 5 to 6 days, which were associated with a 3-fold and 2-fold increased risk of readmission. PTx for secondary versus primary hyperthyroidism was associated with a 2.5 times higher risk.

“To improve readmission rates after parathyroidectomy in patients with CKD, we propose focusing on accurate, appropriate medication reconciliation and optimizing communication and transitions of care to outside facilities (skilled nursing, dialysis, etc) to facilitate the comprehensive care of this high-risk patient population,” Dr Teng and collaborators wrote.

CKD patients undergoing outpatient PTx were not included in the database, which was a study limitation.

 

Reference

Ferrandino R, Roof S, Ma Y, et al. Unplanned 30-Day readmissions after parathyroidectomy in patients with chronic kidney disease: A nationwide analysis otolaryngology. Otolaryngol—Head Neck Surg. doi: 10.1177/0194599817721154

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