2008 Annual Meeting Abstracts
Outcomes Following Thyroidectomy and Parathyroidectomy in Pregnant Women in the US
SreyRam Kuy, MD1, Sanziana Roman, MD2, Leon Boudourakis3, Julie Ann Sosa, MD2.
1University of Texas Health Science Center at San Antonio Department of Surgery, Yale University School of Medicine, Robert Wood Johnson Clinical Scholars Program, New Haven, CT, USA, 2Yale University School of Medicine, Department of Surgery, New Haven, CT, USA, 3Yale University School of Medicine, New Haven, CT, USA.
Objective: (1) To perform the first population-based measurement of complication rates and length of stay (LOS) after thyroid and parathyroid surgery in pregnant women. (2) To identify predictors of outcome.
Design: Retrospective cross-sectional cohort study.
Setting: Health Care Utilization Project-Nationwide Inpatient Sample (HCUP-NIS), a 20% sample of US non-federal hospitals.
Patients: All pregnant women who underwent thyroid and parathyroid surgery were compared to non-pregnant women undergoing the same procedures, 1999-2005.
Interventions: Statistical analyses with chi-square, Student’s t-test, and ANOVA.
Main Outcome Measures: Complications (fetal, general, endocrine-specific [recurrent laryngeal nerve injury and hypocalcemia], pregnancy-related procedures), in-hospital death, and mean LOS.
Results: 202 pregnant women underwent thyroid (n=166) and parathyroid (n=36) procedures. Mean age was 29 years; 46% were white, 21% were emergency/urgent admissions, and 46% had thyroid cancer. Compared to non-pregnant women (n=69,754), pregnant patients had a significantly higher rate of general (10.8 vs 5.8%, p=0.002) and endocrine-specific complications (15.8 vs 7.2%, p < 0.001), as well as longer LOS (4.4 vs 2.2 days, p<0.001). The fetal complication rate was 11.4%, and the pregnancy-related procedure rate was 4.5%. There were no in-hospital deaths among pregnant women who underwent surgery. Compared to pregnant patients with private insurance, those with Medicaid had higher rates of general (41.4 vs 15.9%, p = 0.004) and endocrine-specific complications (31 vs 9%, p = 0.005).
Conclusions: Thyroid and parathyroid surgery during pregnancy was associated with increased rates of endocrine-specific and general complications and longer LOS. Maternal and fetal adverse events were not uncommon. Pregnant patients who require these procedures should be referred to centers of excellence in both endocrine surgery and maternal-fetal medicine.