Outcomes following thyroid and parathyroid surgery in pregnant women

Arch Surg. 2009 May;144(5):399-406; discussion 406. doi: 10.1001/archsurg.2009.48.


Objectives: To perform the first population-based measurement of clinical and economic outcomes after thyroid and parathyroid surgery in pregnant women and identify the characteristics of this population and the predictors of outcome.

Design: Retrospective cross-sectional study.

Setting: Health Care Utilization Project Nationwide Inpatient Sample (HCUP-NIS), a 20% sample of nonfederal US hospitals.

Patients: All pregnant women, compared with age-matched nonpregnant women, who underwent thyroid and parathyroid procedures from 1999 to 2005.

Main outcome measures: Fetal, maternal, and surgical complications, in-hospital mortality, median length of stay, and hospital costs.

Results: A total of 201 pregnant women underwent thyroid (n = 165) and parathyroid (n = 36) procedures and were examined together. The mean age was 29 years, 60% were white, 25% were emergent or urgent admissions, and 46% had thyroid cancer. Compared with nonpregnant women (n = 31 155), pregnant patients had a higher rate of endocrine (15.9 vs 8.1%; P < .001) and general complications (11.4 vs 3.6%; P < .001), longer unadjusted lengths of stay (2 days vs 1 day; P < .001), and higher unadjusted hospital costs ($6873 vs $5963; P = .007). The fetal and maternal complication rates were 5.5% and 4.5%, respectively. On multivariate regression analysis, pregnancy was an independent predictor of higher combined surgical complications (odds ratio, 2; P < .001), longer adjusted length of stay (0.3 days longer; P < .001), and higher adjusted hospital costs ($300; P < .001). Other independent predictors of outcome were surgeon volume, patient race or ethnicity, and insurance status.

Conclusions: Pregnant women have worse clinical and economic outcomes following thyroid and parathyroid surgery than nonpregnant women, with disparities in outcomes based on race, insurance, and access to high-volume surgeons.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Chi-Square Distribution
  • Cross-Sectional Studies
  • Female
  • Hospital Mortality
  • Humans
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data
  • Parathyroid Diseases / mortality
  • Parathyroid Diseases / surgery*
  • Pregnancy
  • Regression Analysis
  • Retrospective Studies
  • Risk Factors
  • Thyroid Diseases / mortality
  • Thyroid Diseases / surgery*
  • Treatment Outcome