Some thyroidectomy outcome measures could be useful as national hospital quality improvement metrics, according to a recent study.
Data from a retrospective cohort study indicated that hospital performance is related to postoperative hypocalcemia and recurrent laryngeal nerve (RLN) injury, a correlation close enough to suggest that the measure could be used to assess overall hospital quality.
Thirty-day hypocalcemia and RLN injury rates were lower among the best-performing hospitals participating in the ACS National Surgical Quality Improvement Program (ACS-NSQIP), the researchers reported.
For hypocalcemia, four hospitals were considered low and seven were high outliers. For RLN injury, eight hospitals were low and 14 were high outliers.
The authors noted that more than 70,000 thyroidectomies are performed annually in the United States. The most relevant potential complications are hypocalcemia, RLN injury, and cervical hematoma, they say.
The analysis included 14,540 patients who underwent thyroidectomies at 98 hospitals. Hospital performance varied for hypocalcemia and RLN injury but not for hematoma.
“Hospital performance rankings were largely unaffected by the inclusion of thyroidectomy-specific data in risk adjustment. With regard to processes, patients undergoing thyroidectomies at the best-performing vs. worst-performing hospitals less frequently had their postoperative parathyroid hormone level measured [19.9% vs. 31.7%], and more often were prescribed oral calcium, vitamin D, or both [76.6% vs. 66.8%],” according to the report. “When profiled by RLN injury, use of energy devices [69.1% vs. 507 55.2%] and intraoperative nerve monitoring [55.7% vs. 346 37.7%] were more prevalent at the best, compared with the worst-performing hospitals.”
The researchers concluded that “Postoperative hypocalcemia and RLN injury, but not hematoma, potentially could be used as thyroidectomy-specific national hospital quality improvement metrics. Strategies aimed at reducing these complications after thyroidectomy may improve the care of these patients.”
An abstract of the study is available online at: http://bit.ly/2Au9U7g.
