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SreyRam Kuy, MD; Sanziana A. Roman, MD; Rani Desai, PhD; Julie Ann Sosa, MA, MD

Arch Surg. 2009;144(5):399-406.

Objectives  To perform the first population-based measurement of clinical and economic outcomes after thyroid and parathyroid surgery in pregnant women and identify the characteristics of this population and the predictors of outcome.

Design  Retrospective cross-sectional study.

Setting  Health Care Utilization Project Nationwide Inpatient Sample (HCUP-NIS), a 20% sample of nonfederal US hospitals.

Patients  All pregnant women, compared with age-matched nonpregnant women, who underwent thyroid and parathyroid procedures from 1999 to 2005.

Main Outcome Measures  Fetal, maternal, and surgical complications, in-hospital mortality, median length of stay, and hospital costs.

Results  A total of 201 pregnant women underwent thyroid (n = 165) and parathyroid (n = 36) procedures and were examined together. The mean age was 29 years, 60% were white, 25% were emergent or urgent admissions, and 46% had thyroid cancer. Compared with nonpregnant women (n = 31 155), pregnant patients had a higher rate of endocrine (15.9 vs 8.1%; P < .001) and general complications (11.4 vs 3.6%; P < .001), longer unadjusted lengths of stay (2 days vs 1 day; P < .001), and higher unadjusted hospital costs ($6873 vs $5963; P = .007). The fetal and maternal complication rates were 5.5% and 4.5%, respectively. On multivariate regression analysis, pregnancy was an independent predictor of higher combined surgical complications (odds ratio, 2; P < .001), longer adjusted length of stay (0.3 days longer; P < .001), and higher adjusted hospital costs ($300; P < .001). Other independent predictors of outcome were surgeon volume, patient race or ethnicity, and insurance status.

Conclusions  Pregnant women have worse clinical and economic outcomes following thyroid and parathyroid surgery than nonpregnant women, with disparities in outcomes based on race, insurance, and access to high-volume surgeons.

Author Affiliations: Robert Wood Johnson Clinical Scholars Program (Drs Kuy and Desai), Division of Endocrine Surgery, Department of Surgery (Drs Roman and Sosa), and School of Epidemiology (Dr Desai), Yale University School of Medicine, New Haven, Connecticut; United States Department of Veterans Affairs, Washington, DC, and Department of Surgery at University of Texas Health Science Center at San Antonio, San Antonio (Dr Kuy); and the Veterans Affairs Connecticut System, Newington, Connecticut (Dr Desai).

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Arch Surg. 2009;144(5):406.
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