Date of Award

January 2011

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Julie Ann Sosa

Subject Area(s)

Medicine

Abstract

REHOSPITALIZATIONS FOLLOWING THYROIDECTOMY AMONG MEDICARE BENEFICIARIES. Charles T. Tuggle and Julie Ann Sosa. Section of Endocrine Surgery, Department of Surgery, Yale University, School of Medicine, New Haven, CT.

Thyroid cancer increases in incidence and aggressiveness with age. The elderly are the fastest growing segment of the U.S. population. Reducing rates of rehospitalization would lower cost and improve quality of care. The SEER-Medicare linked database was used to identify patients >65 years with thyroid cancer who underwent thyroidectomy from 1997-2002. Patient and hospital characteristics were studied as predictors of rehospitalization. Outcomes were 30-day unplanned rehospitalization rate, cost, and length of stay (LOS) of readmission. Of 2,127 patients identified, 69% were female, 84% had differentiated thyroid cancer, and 52% underwent total thyroidectomy. Mean age was 74 years. 171 patients (8%) underwent 30-day unplanned rehospitalization. Rehospitalization was associated with increased comorbidity (17% for a Charlson index of moderate/high vs 6% for an index of none; P<.001), advanced stage (22% for distant stage vs 6% for local disease; P<.001), number of lymph nodes examined (12% for >10 nodes vs 7% for 0 nodes; P=.011), increased LOS of index admission (mean of 4.8 days vs 2.9 days; P<.001), and small hospital size (9% vs 6% for large hospitals; P=.026). Patients with a complication during index hospital stay were more likely to be readmitted (14% vs 6%; P<.001), while patients who saw an outpatient medical provider following index discharge returned less frequently (5% vs 11%; P<.001). Forty seven percent of readmissions were for endocrine-related causes. Mean LOS and cost of rehospitalization were 3.5 days and $5,921, respectively. Unplanned rehospitalization was associated with death at one year compared to non-rehospitalized patients (18% vs 6%; P<.001). Rehospitalizations among Medicare beneficiaries with thyroid cancer following thyroidectomy are prevalent and costly. Further study of predictors could identify high-risk patients for whom enhanced preoperative triage, improved discharge planning, and increased outpatient support might prove cost-effective.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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