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Complications after Thyroidectomy andParathyroidectomy at Teaching Hospitals: A

Nationwide Inpatient Sample Analysis

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The surgical residency training modelof graduated responsibility leads tothe perception amongst healthprofessionals and the public at largethat there may be a greater risk ofcomplications for patients treated at

academic teaching hospitals

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!or surgeries performed at teaching hospitals"there is also the perception that care recei#edat the beginning of the academic year more

ha$ardous As newly graduated physicians begin their

training" and as %unior residents assume new"more senior roles" they may not ha#e the

e&perience necessary to pre#ent patientcomplicationspublic perception thatacademic hospitals are dangerous near thebeginning of the academic year

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Thyroidectomy andparathyroidectomy are among themost commonly performed general

surgery procedures" and areconsidered to be relati#ely safe

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'aterial and 'etods

The Nationwide Inpatient Sample(NIS)" administered by theHealthcare Cost and *tili$ation

Pro%ect (HC*P) and is a large nationaldatabase that collects data on allpatients discharged from a sample of

appro&imately +,,, *S hospitalseach year" which representsappro&imately -,. of all hospital

discharges in a gi#en year

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All patients in the -,+, NIS databaseundergoing thyroidectomy orparathyroidectomy were di#ided into

two cohorts based on whether theprocedure was performed at anacademic teaching hospital for

further comparati#e analysis

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statistical analyses STATA #ersion +-

/i#ariate analysis on cohorts was done usingStudent0s t1test

categorical #ariables 2- analysis The primary dependent #ariables of interest

were total complications" bleedingcomplications" #ocal cord paralysis" and

hypocalcemia

Secondary dependent #ariables includedlength of stay and total charges

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'ultiple logistic regression modelsfor the dependent #ariables ofinterest were created using hospital

teaching status" patientcomorbidities" payer source" electi#e#s emergent admission" race" se&"

and age A signi3cance le#el of,,4. was considered signi3cant forall tests

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56S*7T

In -,+," an estimated 89"8-4 patientsunderwent thyroidectomy orparathyroidectomy in the *S

+4"8-, patients were captured by the NISdatabase and were included in the analysis

Thyroidectomy 4. of patients"

parathyroidectomy +4.

The most common surgery performed wastotal thyroidectomy

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Concomitant laryngectomy (,9.)

neck dissection was more common(49.)

!emale884. mean age was4;4 years

The a#erage length of stay (7,;98

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In this study" we found that complication ratesafter thyroidectomy and parathyroidectomy arecomparable when performed at teaching andnon1teaching hospitals

a lower risk of complications at teachinghospitals

The most feared complications of theseprocedures include bleeding" hypocalcemiasecondary to inad#ertent remo#al or in%ury tothe parathyroid glands" and #ocal cord paralysisdue to recurrent laryngeal ner#e in%ury

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the only one found to ha#e higherrates at teaching hospitals was #ocalcord paralysis this increase was

relati#ely small" and is likely to be oflittle clinical signi3cance

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In conclusion" thyroidectomy andparathyroidectomy is safe o#erall Complicationsare similar whether the procedures areperformed at teaching hospitals or non1teachinghospitals Thus" these procedures can be safelyperformed at teaching hospitals The resultspresented here can help to dispel the myth thatthere is a ?uly e@ect for complications at

teaching hospitals Surgeons can use these datato assure their patients of the low risk associatedwith thyroidectomy and parathyroidectomy