23-hour observation endocrine neck surgery: lessons learned from a case series of over 1700 patients

Raspanti, C; Porrello, Calogero; Augello, Giovanni; Dafnomili, A; Rotolo, G; Randazzo, A; Falco, N; Fontana, Tommaso; Tutino, Roberta; Gulotta, Gaspare

doi:10.11138/gchir/2017.38.1.015

Cited by 5 publications

(5 citation statements)

References 38 publications

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“…[28][29][30][31] There was also no case of symptomatic hypocalcemia in the series, though some other studies showed hypocalcemia to be the most common morbidity post thyroidectomy. 7,[32][33][34] Zero incidence of hypocalcemia may have been due to the very few cases of total thyroidectomy in the study.…”

Section: Discussionmentioning

confidence: 99%

“…The advantages of reduction in hospital stay include reduced costs, reduced in-patient waiting lists, increased availability of in-patient beds, reduced post-op complications, and the psychological benefit of avoiding prolonged hospitalization. 6,7 Although short stay thyroidectomy is commonly practiced in developed countries all over the world, the practice is still nascent in developing nations like Nigeria. Reasons for this include a lack of resources, including medical technology, adequately skilled personnel, and poor socioeconomic status of a vast majority of patients.…”

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confidence: 99%

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The outcome of short stay thyroidectomy in rural medical outreach settings in Northern Nigeria

2020

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Background: The practice of short stay thyroidectomy is relatively new in developing nations like Nigeria. The primary reason for this is a lack of resources. Furthermore, the prevailing poverty prevents many patients from accessing tertiary health care, as such, ad hoc medical outreaches are usually conducted to bridge the gap. Thyroidectomies have not been routinely performed in these outreach settings due to safety concerns. The study seeks to analyse whether short stay thyroidectomy can be safely practiced under medical outreach settings with limited resources.Methods: The study is a prospective review of all patients that had short stay thyroidectomy at four rural medical outreach settings in Nigeria. Entire study spanned January 2019 to November 2019. Each outreach lasted one week, and patients were followed up for the duration of the outreach. All patients presenting at the outreach locations and diagnosed with goiters who have had no prior neck surgeries, are euthyroid, have no locally advanced malignancies or intrathoracic goiters, have adequate social support, possess a telephone, and have accommodation within the local government area where the outreach is carried out were included in the study. Exclusion criteria included patients who did not satisfy any of the above listed inclusion criteria. Thyroidectomy was done through a standard cervicotomy. Descriptive statistics were applied.Results: A total of 81 patients with non-toxic goiters had thyroid surgery. There were 76 (94%) females and five (6%) males. Average age was 46 years. Sixty-nine (85.2%) patients had no complication, while 12 (14.8%) patients had complications. Seventy-seven (95.1%) patients were discharged within 24 hours of surgery, while four (9.4%) patients were discharged within 48 hours. There was no mortality.Conclusions: The short-stay thyroidectomy model is feasible and safe in our environment, even in the presence of limited resources, and provides an alternative to the traditional 72 hour postoperative hospital stay.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

The outcome of short stay thyroidectomy in rural medical outreach settings in Northern Nigeria

2020

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“…One of the most important aspects of the protocol approach is patient selection. Patient selection should consider the patient's general clinical concerns, access to health system, and social support [20]. General clinical considerations include medical contraindications that could necessitate a higher level of care or medical subspecialty consultation.…”

Section: Pathways For 23 H Observationmentioning

confidence: 99%

“…These benefits have increased the types of surgical procedures that can be done safely in an ambulatory setting. Factors to consider when selecting appropriate surgical procedures can include distance of the 23 h unit to an inpatient hospital, length of the surgical procedure, facility resources, historical length of stay of the procedure, and surgeon complication rate, among others [20]. With appropriate planning, complicated procedures such as arthroplasties can be performed on an outpatient basis (whether SDD or overnight stay) with a high degree of patient satisfaction [21].…”

Section: Pathways For 23 H Observationmentioning

confidence: 99%

Twenty-three-hour stays in the ambulatory surgical center: benefits, pathways and protocols

Ardon,

Nimma,

Nin

2023

Current Opinion in Anaesthesiology

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Purpose of review To summarize recent evidence that discusses the clinical, financial, and logistical implications of a 23 h stay postsurgical stay unit in an ambulatory surgical center (ASC). Recent findings Twenty-three-hour stays in ambulatory surgery centers are safe, but proper patient selection and optimization are key to maintaining a high level of safety. The financial implications of overnight stays in ASCs rely heavily on payment structures and comparative costs at hospital-based outpatient surgery centers. The establishment of pathways and protocols for clinical care are key to the success of a 23 h stay at an ASC Summary A concurrent concern with the recent increase in outpatient surgery and medical complexity of cases performed in an ambulatory surgical center (ASC) is the possibility that patients may need overnight stay. Further, whether certain patients would benefit from anticipated 23 h observation rather than same-day discharge is an emerging topic. Overnight stays in ASCs may have financial advantages and decrease the risk of unanticipated admission with proper patient selection. The use of protocols and established pathways is key to the success of this model.

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“…In Australia, 23‐h care is recorded from the time of admission to the recovery unit to the time of discharge from the unit. Recently, Raspanti and colleagues reported a success rate of 90 per cent in 1700 patients who had thyroid surgery within the 23‐h model, with a mean hospital stay of 1·1 days.…”

Section: Introductionmentioning

confidence: 99%

Implementation of a 23-h surgery model in a tertiary care hospital: a safe and feasible model with high patient satisfaction

et al. 2020

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Background: The 23-h surgery model consists of elective operative care with an overnight hospital stay for patients unsuitable for day case surgery. The aim of this study was to assess the success of the 23-h surgery model. Methods:This was a prospective follow-up study of patients undergoing surgery with the planned 23-h model in a tertiary-care university hospital during a 12-month period 2 years after the model was implemented. Patients were interviewed 2 weeks after surgery, and the hospital operative database and patient records were searched. The primary outcome was the success of the process, defined as discharge before 10.00 hours on the first morning after surgery. Secondary outcomes were 30-day readmission and reoperation rates, adverse events, and patient satisfaction with the process. Results: Between May 2017 and May 2018, 993 adult patients underwent surgery with the 23-h model, of whom 937 adhered to the model as planned (success rate 94⋅4 per cent). Gynaecological, gastrointestinal and orthopaedic surgery were the three most common surgical specialties. The surgical process was changed to an in-hospital model for 45 patients (4⋅5 per cent), and 11 (1⋅1 per cent) were discharged on the day of surgery. The readmission rate was 1⋅9 per cent (19 of 993), and five patients (0⋅5 per cent) had a reoperation within 30 days of surgery. Fifty-nine adverse events were noted in 53 patients (5⋅3 per cent), most commonly infection. Patient satisfaction was a median of 6-7 (maximum 7) points for various aspects of the model. Conclusion: The success rate and patient satisfaction for the 23-h surgery model was high.

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23-hour observation endocrine neck surgery: lessons learned from a case series of over 1700 patients

Abstract: SUMMARY: 23-hour observation endocrine neck surgery: lessons learned from a case series of over 1700 patients.

Cited by 5 publications

References 38 publications

The outcome of short stay thyroidectomy in rural medical outreach settings in Northern Nigeria

The outcome of short stay thyroidectomy in rural medical outreach settings in Northern Nigeria

Twenty-three-hour stays in the ambulatory surgical center: benefits, pathways and protocols

Implementation of a 23-h surgery model in a tertiary care hospital: a safe and feasible model with high patient satisfaction

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