Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Objectives: This study evaluates the predictors of length of stay (LOS), post-operative complications, and hospital costs in patients undergoing total thyroidectomy. It aims to identify risk factors that stratify patients by risk of complication to aid in estimating length of stay in advance of surgery and to estimates cost differences across varying lengths of stay.
Methods: The National Inpatient Sample (NIS) Healthcare Cost and Utilization Project (HCUP) Agency for Healthcare Research and Quality database for the years 2016 – 2021 was used. Patients aged 18 or older who underwent total thyroidectomy and were hospitalized for less than 3 days were included. Patients with partial resections or non-elective admissions, as well as those who died during their hospital stay, were excluded. Independent variables included demographics, comorbidity using the Elixhauser Comorbidity Score, and hospital characteristics. Variables of interest were post-operative complications, hospital costs, and length of stay categorized as same-day discharge, overnight stay, and two-day stay. Univariate linear regressions of length of stay on predictors was performed. Multivariate logistic regressions were performed to evaluate predictors of complications, and multivariate linear regressions were conducted for analyzing hospital costs. Costs were generated using total charges adjusted by each hospital’s cost-to-charge ratio and adjusted for inflation to 2021 prices using the Consumer Price Index for Medical Care.
Results: A total of 27,450 patients were included, with 890 having same-day discharge, 18,550 having overnight stays, and 8,010 having two-day stays. Complications had the greatest magnitude of impact on increasing length of stay on univariate regression. Two-day stays had the highest rates of thyroidectomy-specific complications, including hypoparathyroidism, hemorrhage or hematoma, and vocal cord paralysis or voice dysfunction. Neck dissection increased the risk of vocal cord paralysis, while female and younger patients had higher likelihoods of hypoparathyroidism. There was no significant difference in complication rates or hospital cost between same-day discharges and overnight stays. However, after controlling for demographic differences, comorbidity, and having had a complication, two-day stays cost an average of $3,490.12 more than an overnight stay (95% CI: 3004.76 to 3975.48; p < 0.001).
Conclusions: The study confirms that complications are associated with the greatest increase in LOS and identifies risk factors associated with an increased likelihood of complication. Patients can be stratified based on these predictors to help in providing estimations of expected hospital stays in order to ensure adequate insurance coverage and set patient expectations. Same-day discharge demonstrated equivalent safety to overnight stays in appropriate patients, with the two groups showing similar complication rates. Similar rates of reimbursement for any hospitalizations of less than 24 hours results in a lack of significant cost difference between same-day discharge and overnight stays. However, two-day stays are associated with significantly higher costs compared to overnight stays even when controlling for other factors that increase cost. Future studies should focus on identifying factors that predict the severity of complications, which could further refine risk stratification and hospital stay estimations.