Abstract
Objective: Each year 45 million surgical procedures are performed in the United States, and a significant number of these are performed on hypothyroid patients. Little guidance is available to determine the postoperative risk to these subjects. We hypothesized that new surgical techniques and modern anesthesia would lead to no differences in outcome between hypothyroid patients and euthyroid controls. Methods: We queried surgical databases in our health system for patients who underwent an operative procedure between January 1, 2010 and December 31, 2015 with a TSH > 10 mcU/mL or a FT4 < 0.6 ng/dL. Identified patients were matched to euthyroid controls selected for age, sex, surgical procedure, and search interval. Predicted length of hospital stay (LOS) was determined using the American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator. Results: We identified 29 hypothyroid patients. The LOS was significantly longer for the hypothyroid patients compared to the predicted LOS (14.4 vs 6.7 days, P < 0.001). The LOS in the matched controls was not significantly different than their predicted LOS (9.6 vs 7.1 days, P = 0.11). Other complications were not different between the hypothyroid and control patients. Conclusions: In contrast to our initial hypothesis, hypothyroidism is associated with a 2-fold longer LOS following surgery. Hypothyroidism continues to place patients at increased surgical risk.
Highlights
IntroductionMany institutions have made the investment to provide preoperative evaluation
Since the hypothyroid patients had a significantly longer length of stay compared with the predicted length of stay, we looked at the relationship between the length of stay and the serum TSH
Our study was prompted by reports that surgical outcomes may be improved with pre-operative assessment of patient comorbidities
Summary
Many institutions have made the investment to provide preoperative evaluation. Evidence that this activity improves outcomes is controversial. Some evidence indicates that preoperative evaluation is beneficial [1] [2] [3], but at least one study suggests that these evaluations may prolong hospital stay and increase mortality [1]. We are unaware of any study that suggests a benefit to screening for hypothyroidism in the preoperative evaluation
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