Sex-Stratified Predictors of Prolonged Operative Time and Hospital Admission in Outpatient Parathyroidectomy

Our retrospective database study investigates sex-stratified predictors of prolonged operative time (POT) and hospital admission following parathyroidectomy for primary hyperparathyroidism (PHPT). The 2016 to 2018 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried for patients with PHPT undergoing parathyroidectomy. Cases analyzed were all outpatient status, arrived from home, coded as non-emergent, and elective. POT was defined by the 75th percentile. Hospital admission was defined as LOS \(\ge\) 1 day. Univariate and multivariable binary logistic regressions were utilized. Of 7442 cases satisfying inclusion criteria, the majority were female (78.0%) and White (78.5%). Median OT (IQR) for females and males was 77 (58–108) and 81 (61–109) minutes, respectively (P = 0.003). 1965 (33.9%) females and 529 (32.3%) males required hospital admission. Independent predictors of POT included ASA class III/IV (aOR 1.342, 95% CI 1.007–1.788) and obesity (aOR 1.427, 95% CI 1.095–1.860) for males (P < 0.05). Independent predictors of hospital admission included age (aOR 1.008, 95% CI 1.002–1.014), ASA class III/IV (aOR 1.490, 95% CI 1.301–1.706), obesity (aOR 1.309, 95% CI 1.151–1.489), dyspnea (aOR 1.394, 95% CI 1.041–1.865), chronic steroid use (aOR 1.674, 95% CI 1.193–2.351), and COPD (aOR 1.534, 95% CI 1.048–2.245) for females (P < 0.05); and ASA class III/IV (aOR 1.931, 95% CI 1.483–2.516) and bleeding disorder (aOR 2.752, 95% CI 1.443–5.247) for males (P < 0.005). In conclusion, predictors of POT and hospital admission following parathyroidectomy for PHPT differed by patient sex. Identifying patients at risk for POT and hospital admission may optimize healthcare resource utilization.

Level of Evidence: IV.