Appropriate selection of candidates for outpatient thyroidectomy

Abstract

Purpose of review Although traditionally an inpatient procedure, outpatient thyroidectomy has gained traction as a viable and well tolerated alternative for selected patients, with an added benefit of cost savings. Recent findings Research on outpatient thyroidectomy has focused on establishing its noninferiority in outcomes compared to the standard inpatient or overnight observation. Numerous studies have found comparable low rates of postoperative complications and no increase in readmission. Selection criteria have been well established by professional societies and research studies support the selection bias benefitting appropriately selected patients. The primary benefit of outpatient thyroidectomy reported is a decrease in cost, though additional theoretical benefits such as decreased exposure to nosocomial infections. Summary Outpatient thyroidectomy is a well tolerated approach in appropriately selected candidates, with cost reduction benefits. Adherence to societal guidelines for patient selection is paramount.

Unilateral Thyroid Lobectomy as Day Care Procedure: A Cross Sectional Study with Literature Review on the Safety and Cost Effectiveness

“…But careful selection of patients eligible for day care surgery is of utmost importance. 19 In 2013, the ATA gave a consensus statement on the selection of eligible candidates for day care thyroid surgery. This statement emphasized on preoperative, intraoperative and postoperative factors that must be considered while performing a daycare thyroid surgery.…”

“…8,19 The statement also suggested revising the decision of day care surgery in case of challenging hemostasis, locally advanced cancer, massive goiter, sub sternal goiter, or association with Graves or Hashimoto disease. 8,19 The checklist at the time of discharge from day care must include examination of operative site for any swelling, difficulty in swallowing liquids should be alarming, pain control on oral medications, and red flag signs must be explained to the patient and caregiver. 8,9 Our study intended to address the apprehensions of the local community of head and neck surgeons.…”

“…The patient should have preoperative education, there should be a primary caregiver available, and the patient should stay in proximity to a skilled facility. 8 19 The statement also suggested revising the decision of day care surgery in case of challenging hemostasis, locally advanced cancer, massive goiter, sub sternal goiter, or association with Graves or Hashimoto disease. 8 19 The checklist at the time of discharge from day care must include examination of operative site for any swelling, difficulty in swallowing liquids should be alarming, pain control on oral medications, and red flag signs must be explained to the patient and caregiver.…”

The safety, benefits and future development of overnight and outpatient thyroidectomy

“…Age is not a determining factor preventing patients and physicians from choosing outpatient thyroidectomy ( 44 ). At present, outpatient thyroidectomy is known to be safe and effective in adults, but few studies focus on children and adolescents.…”

Unplanned Return to Hospital After Same Day Oral Cavity Resection: A Dual Institution Study

“…Numerous publications demonstrated safety and efficacy. [7][8][9][10] Careful patient selection for appropriate same day discharge requires consideration of social support, access to care, and medical comorbidities. 11 The addition of sentinel lymph node biopsy to the treatment algorithm for early stage oral cavity cancers may allow some patients to avoid more extensive upfront surgery with neck dissection that requires an inpatient stay, [12][13][14] and more patients may be treated with outpatient surgery as sentinel lymph node biopsy gains popularity.…”