Systematic Review and Meta-Analysis of Unplanned Reoperations, Emergency Department Visits and Hospital Readmission After Thyroidectomy

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Abstract
Background: Unplanned reoperation, emergency department (ED) visits, and hospital readmission following thyroid operations usually arise due to complications and are a source of frustration for both surgeons and patients. With the aim of providing insight important for the development of patient quality care improvement initiatives, the primary objective of this review was to evaluate the available literature systematically in order to determine the contemporary rates of reoperation, readmission, and ED visits following thyroid operations. A secondary study objective was to determine if there were any practices that showed promise in reducing the occurrence of these undesirable postoperative events. Methods: This systematic review was conducted in accordance with the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses protocols. Twenty-two studies were included in the systematic review. Meta-analysis was performed to obtain the weighted-pooled summary estimates of rates of reoperations, ED visits, and unplanned hospital readmission. Jackknife sensitivity analyses were performed for each data set. Finally, in order to detect the risk of publication bias and the small-study effect, funnel plot analysis was performed. Results: The pooled rate estimate for reoperation was very low (0.6% [confidence interval (CI) 0.3–1.1%]). This was subject to publication bias because smaller studies tended to report lower rates of reoperation. The pooled rate of ED visits was 8.1% [CI 6.5–9.8%], while the pooled rate of hospital readmission from 19 studies was 2.7% [CI 2.1–3.4%]. Neck hematoma was the most common reason for reoperation, while postoperative hypocalcemia was the most common reason for hospital readmission. Conclusions: ED visits and hospital readmission after thyroidectomy are common, and there are several practices that can reduce their occurrence. Routine postoperative calcium and vitamin D supplementation may reduce rates of postoperative hypocalcemia, and avoiding postoperative hypertension may decrease the risk of neck hematoma development and the need for reoperation. Older age, thyroid cancer, dependent functional status, higher ASA score, diabetes, chronic obstructive pulmonary disease, steroid use, hemodialysis, and recent weight loss increase the risk of hospital readmission after thyroid surgery. By further identifying risk factors for reoperation, ED visits, and readmission, this review may assist practitioners in optimizing perioperative care and therefore reducing patient morbidity and mortality after thyroid operations.

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