Impact of Serious Mental Illness and Dementia-Related Disorders on Post-Parathyroidectomy Healthcare Utilization and Cost

Abstract

Background and Objectives

Serious mental illness and dementia-related disorders are associated with worse postoperative outcomes. We evaluated the impact of pre-existing neuropsychiatric disorders on post-parathyroidectomy healthcare utilization.

Methods

Adult patients who underwent parathyroidectomy for primary hyperparathyroidism were identified in the Healthcare Cost and Utilization Project State Inpatient and Ambulatory Surgery Databases (2016–2021). Neuropsychiatric disorders were classified. The primary outcome was 30-day readmission. Secondary outcomes were length of stay and costs (2021USD). Balancing weights were used for covariate adjustment. Subgroup analyses were performed in serious mental illness and dementia-related disorder groups.

Results

Of 10,733 parathyroidectomy patients, 1,249 (11.6%) had neuropsychiatric disorders: 60.5% mood, 58.8% anxiety, 5.1% dementia-related, and 1.8% schizophrenia-type disorders. Patients with neuropsychiatric disorders were younger and more likely to undergo emergent/urgent parathyroidectomy (p < 0.001).

There was no difference in adjusted odds of readmission between patients with and without neuropsychiatric disorders (0.91[95%CI 0.55, 1.49], p = 0.710). Adjusted length of stay was 0.20 days longer among patients with neuropsychiatric disorders ([95%CI: + 0.11, + 0.30]; p < 0.001). Adjusted encounter costs were similar between groups (median[IQI]: neuropsychiatric disorder $6767[5290,8589] vs. no neuropsychiatric disorder $6511[5259, 8550]; p = 0.080). Subgroup analyses showed similar results.

Conclusions

Patients with neuropsychiatric disorders have similar parathyroidectomy readmission and cost. They have slightly longer length of stay that may ameliorate the risk of readmission.