Sex-Stratified Predictors of Prolonged Operative Time and Hospital Admission in Outpatient Parathyroidectomy

Aman M Patel; Ariana L Shaari; Owais M Aftab; Mehdi S Lemdani; Hassaam S Choudhry; Andrey Filimonov

doi:10.1007/s12070-023-04444-3

Sex-Stratified Predictors of Prolonged Operative Time and Hospital Admission in Outpatient Parathyroidectomy

Indian J Otolaryngol Head Neck Surg. 2024 Apr;76(2):1910-1920. doi: 10.1007/s12070-023-04444-3. Epub 2024 Jan 8.

Authors

Aman M Patel¹, Ariana L Shaari¹, Owais M Aftab¹, Mehdi S Lemdani¹, Hassaam S Choudhry¹, Andrey Filimonov¹

Affiliation

¹ Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ USA.

PMID: 38566654
PMCID: PMC10982178 (available on 2025-04-01)
DOI: 10.1007/s12070-023-04444-3

Abstract

Our retrospective database study investigates sex-stratified predictors of prolonged operative time (POT) and hospital admission following parathyroidectomy for primary hyperparathyroidism (PHPT). The 2016 to 2018 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried for patients with PHPT undergoing parathyroidectomy. Cases analyzed were all outpatient status, arrived from home, coded as non-emergent, and elective. POT was defined by the 75th percentile. Hospital admission was defined as LOS $\geq$ 1 day. Univariate and multivariable binary logistic regressions were utilized. Of 7442 cases satisfying inclusion criteria, the majority were female (78.0%) and White (78.5%). Median OT (IQR) for females and males was 77 (58-108) and 81 (61-109) minutes, respectively (P = 0.003). 1965 (33.9%) females and 529 (32.3%) males required hospital admission. Independent predictors of POT included ASA class III/IV (aOR 1.342, 95% CI 1.007-1.788) and obesity (aOR 1.427, 95% CI 1.095-1.860) for males (P < 0.05). Independent predictors of hospital admission included age (aOR 1.008, 95% CI 1.002-1.014), ASA class III/IV (aOR 1.490, 95% CI 1.301-1.706), obesity (aOR 1.309, 95% CI 1.151-1.489), dyspnea (aOR 1.394, 95% CI 1.041-1.865), chronic steroid use (aOR 1.674, 95% CI 1.193-2.351), and COPD (aOR 1.534, 95% CI 1.048-2.245) for females (P < 0.05); and ASA class III/IV (aOR 1.931, 95% CI 1.483-2.516) and bleeding disorder (aOR 2.752, 95% CI 1.443-5.247) for males (P < 0.005). In conclusion, predictors of POT and hospital admission following parathyroidectomy for PHPT differed by patient sex. Identifying patients at risk for POT and hospital admission may optimize healthcare resource utilization. Level of Evidence: IV.

Supplementary information: The online version contains supplementary material available at 10.1007/s12070-023-04444-3.

Keywords: Admission; NSQIP; Operative time; Parathyroidectomy; Sex.

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