Retrospective cohort study of trends in the use of outpatient parathyroidectomy by surgical indication.

Abstract

A shift toward outpatient parathyroidectomy was seen in the early 2000s. Recent trends, especially for secondary and tertiary hyperparathyroidism, have not been described. This study evaluates temporal trends in same-day, overnight, and inpatient parathyroidectomy by surgical indication. Adult patients who underwent parathyroidectomy were identified in the Healthcare Cost and Utilization Project State Inpatient and State Ambulatory Surgery Databases from 2013 to 2019. Admission type was defined by length of stay as same-day, overnight, or inpatient. Parathyroidectomy indications were classified using International Classification of Diseases, Ninth and Tenth Revision, codes. Patient and hospital characteristics were compared for all parathyroidectomy and for each indication. The Cochran-Armitage test of trend was used to examine admission practice patterns over time for the overall cohort and by surgical indication. Of 67,436 parathyroidectomies, most were outpatient with 45,352 (67.3%) same-day and 17,918 (26.6%) overnight discharges. Among 4,166 (6.2%) inpatient parathyroidectomies, median length of stay was 3 days (interquartile range, 2, 5). The most common indication was primary hyperparathyroidism (n = 45,937; 68.1%). Overall, from 2013 to 2019, there was an increase in the proportion of same-day parathyroidectomy with a decrease in overnight and inpatient status over time. This pattern was driven by the most common indication of primary hyperparathyroidism. In secondary and tertiary hyperparathyroidism, there was an increase in the proportion of same-day parathyroidectomy with an associated decrease in inpatient stays. The trend towards outpatient, particularly same-day parathyroidectomy, has continued for primary hyperparathyroidism. Trend towards outpatient parathyroidectomy is emerging in secondary and tertiary hyperparathyroidism.