Highlights
- •Functional dependent status has been associated with worse perioperative outcomes.
- •Dependent patients also have worse outcomes following thyroidectomies.
- •Outcomes included major complications and increased length of stay.
Abstract
Background
Functional dependency has been associated with increased risk of adverse events following
many surgical procedures. We hypothesized that dependent patients would have an increased
risk of complications following thyroidectomy.
Methods
We performed a retrospective review of total thyroidectomies performed from 1/2012–12/2019
as identified by CPT codes using the National Surgical Quality Improvement Project
(NSQIP) database. Functional dependent status was identified from within the NSQIP
database with partially or totally dependent combined into the dependent group.
Results
A total of 64,978 patients were included, with 0.53% identified as functionally dependent
(FD). Functional dependency was associated with an increased risk of wound disruption,
pneumonia, UTI, stroke, cardiac arrest, PE/DVT, and sepsis/septic shock. Dependent
patients had higher rates of unplanned intubation, ventilator use, and significant
bleeding.
On multivariate analysis, FD patients were more likely to suffer from major complications
and have an increased length of stay.
Conclusions
Dependent status was associated with an increased risk of complications following
thyroidectomy. Focused preoperative and disposition planning for these patients can
help to minimize adverse outcomes and optimize resource utilization.
Keywords
Abbreviations:
FD (Functionally Dependent), FI (Functionally Independent), NSQIP (National Surgical Quality Improvement Project), LOS (Length of Stay), BMI (Body Mass Index), ASA (American Society of Anesthesiology), ADL (Activities of Daily Living)To read this article in full you will need to make a payment
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References
- Epidemiological and economic trends in inpatient and outpatient thyroidectomy in the United States, 1996-2006.Thyroid. 2013; 23: 727-733
- Defining disability, functioning, autonomy and dependency in person-centered medicine and integrated care.Int J Integrated Care. 2010; 10
- Perioperative risk factors for 30-day mortality after bariatric surgery: is functional status important?.Surg Endosc. 2013; 27: 1772-1777https://doi.org/10.1007/s00464-012-2678-5
- Dependent functional status is a risk factor for perioperative and postoperative complications after total hip arthroplasty.J Arthroplasty. 2019; 34https://doi.org/10.1016/j.arth.2018.12.037
Deniston, O L, and A Jette. “A functional status assessment instrument: validation in an elderly population.” Health Serv Res, vol. 15, no. 1, pp. 21–34.
- SS6. Preoperative functional status predicts poor perioperative outcomes after infrainguinal bypass surgery: an NSQIP report.J Vasc Surg. 2009; 49https://doi.org/10.1016/j.jvs.2009.02.137
- Frailty as a predictor of surgical outcomes in older patients.J Am Coll Surg. 2010; 210: 901-908https://doi.org/10.1016/j.jamcollsurg.2010.01.028
- Phenotype of frailty: characterization in the Women's Health and aging studies.J Gerontol: Series A. March 2006; 61: 262-266https://doi.org/10.1093/gerona/61.3.262
- Risk factors for postoperative complications in total thyroidectomy.Medicine. 2017; 96https://doi.org/10.1097/md.0000000000005752
- Thyroidectomy outcomes.Otolaryngology-Head Neck Surg (Tokyo). 2012; 147: 1027-1034https://doi.org/10.1177/0194599812454401
- Preoperative functional status is associated with unplanned intubations following thyroidectomies.Respir Care. 2017; 62: 1277-1283https://doi.org/10.4187/respcare.05575
- Postoperative respiratory failure after thyroid and parathyroid surgery: analysis of national surgical quality improvement program.Head Neck. 2011; 34: 321-327https://doi.org/10.1002/hed.21723
- Systematic review and meta-analysis of unplanned reoperations, emergency department visits and hospital readmission after thyroidectomy.Thyroid. 2018; 28: 624-638https://doi.org/10.1089/thy.2017.0543
- Outcomes after thyroidectomy and parathyroidectomy.Head Neck. 2011; 34: 477-484https://doi.org/10.1002/hed.21757
- Risk factors for 30-day hospital readmission after thyroidectomy and parathyroidectomy in the United States: an analysis of national surgical quality improvement program outcomes.Surgery. 2014; 156: 1423-1431https://doi.org/10.1016/j.surg.2014.08.074
- Patients with poor baseline walking capacity are most likely to improve their functional status with multimodal prehabilitation.Surgery. 2016 Oct; 160 (Epub 2016 Jul 28. PMID: 27476586): 1070-1079https://doi.org/10.1016/j.surg.2016.05.036
Article info
Publication history
Published online: May 26, 2022
Accepted:
May 24,
2022
Received in revised form:
May 11,
2022
Received:
December 6,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
