Background-Thyroid and parathyroid procedures historically have been viewed as inpatient procedures. Due to advancements in surgical techniques, these procedures were transferred from the inpatient operating room (OR) to the outpatient OR at a single academic institution approximately seven years ago. The goal of this study is to determine whether this change has decreased turnover times and maximized OR utilization.

Background Patients traditionally recover overnight on a general surgery ward after a thyroidectomy; however, these units often lack the efficiency and focus for rapid discharge which is the goal of a short-stay unit. Utilizing a short-stay unit for thyroidectomy patients, who are often discharged in <24 hours, may reduce the duration of hospital stay and subsequently decrease associated costs and increase hospital bed and resource availability. Methods A retrospective review of 400 patients undergoing thyroidectomy at a single academic hospital. Post-operative discharge information and hospital cost data were analyzed. Adult patients having stayed a single night in the hospital were included. Comparisons were made between patients staying on a designated short-stay unit (SS) versus a general surgery ward (GS). Results 223 patients were admitted to SS and 177 to GS. Trends of admission location were blocked based on time period with the majority of patients per time period going to the same location. Discharge times varied significantly between patients admitted to SS (p<0.001). 70% of SS patients were discharged before noon versus 40% of GS patients (p<0.001). Many variances were identified to account for these differences. Direct costs were significantly lower with SS, due to savings in pharmacy, recovery room, and nursing expenses (all p<0.01). Conclusions A designated short-stay hospital unit is an effective model for increasing the efficiency of discharge for thyroidectomy patients compared to those admitted to a general surgery ward. It also serves to increase bed availability, which decreases hospital cost and may improve patient flow.

between Pitocin, double lumen cervical ripening balloon (CRB) and prostaglandins (PGs). Since mechanical manipulation might affect the cervix, we aimed to investigate differences in cervical recuperation following different methods of induction and other cervical manipulations. STUDY DESIGN: The study was conducted between june 2016 to june 2018. Following informed consent, cervical length (CL) measurements were performed trans-vaginally following spontaneous and induced vaginal deliveries. All measurements were performed by a single observer (R.L) at 8, 24 and 48 hours postpartum. CL at the second trimester, demographic characteristics, obstetric history, parity, delivery outcomes, previous cervical manipulations and induction mode, were obtained from the patient's' medical records. RESULTS: Our cohort included 498 women. The average CL, 48 hours postpartum, following spontaneous term deliveries (254 women) was 35.2AE3.5 mm. 79 patients were induced with Dinoprostone, 77 with Pitocin and 88 by CRB. Significant abnormal cervical recovery was demonstrated in the CRB group compared to the Pitocin and the PGs groups (26.3AE1.9 mm vs. 35.9AE2.3 mm vs. 34.4AE3.1 mm, respectively (P¼0.012)) ( Fig 1a). One hundred twenty six patients had history of D&Cs, 49 had one D&C, 35 had two D&Cs and 43 patients had more than 2 D&Cs. Patients with more than 2 D&Cs demonstrated abnormal cervical recovery compared to patients that had 2 or 1 D&C (27.9AE2.3 mm vs. 32.6AE2.7 mm vs. 38.5AE1.8 mm, respectively (P¼0.028)) (Fig 1b). CONCLUSION: Cervical manipulations such as mechanical inductions and repeated D&Cs may cause damage to the cervix and increase its`recovery time. This has only been proven for the double lumen cervical ripening balloon and has not been evaluated for a Foley catheter. Although the clinical significance of delayed cervical recuperation postpartum has not been elucidated yet, these results might imply future cervical insufficiency and possible risk of preterm birth. Our results raise the question whether mechanical modes of induction have a negative and possibly long-term effect on the cervix. OBJECTIVE:The objective of this study was to determine if polydioxanone suture compared to polyglactin suture reduced the incidence of wound and fascial complications after cesarean deliveries.ajog.org

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