Increased efficiency of endocrine procedures performed in an ambulatory operating room

Clark, Nicholas; Vrabec, Sara; Bauer, Philip S.; Chen, Herbert; Sippel, Rebecca S.

doi:10.1016/j.jss.2013.04.038

Cited by 30 publications

(17 citation statements)

References 17 publications

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“…More recently, the safety and utility of outpatient thyroidectomy has been reported (1, 24–26). Outpatient thyroidectomy is considered safe for most patients due to a number of advancements, including PTH testing, calcium supplementation, vocal fold evaluation and the use of intraoperative hemostatic agents and energy devices to reduce bleeding (24, 25). In keeping with the efficiency of outpatient operating centers, proper OR scheduling is essential (3).…”

Section: Discussionmentioning

confidence: 99%

Identifying predictors of a difficult thyroidectomy

Mok

Oltmann

Chen

et al. 2014

Journal of Surgical Research

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Introduction A Thyroidectomy Difficulty Scale (TDS) was previously developed that identified more difficult operations, which correlated with longer operative times and higher complication rates. The purpose of this study was to identify pre-operative variables predictive of a more difficult thyroidectomy using the TDS. Methods A four item, 20-point TDS, was used to score the difficulty of thyroid operations. Patient and disease factors were recorded for each patient. Difficult thyroidectomy (DT) and non-difficult thyroidectomy (NDT) patients were compared. A final multivariate logistic regression model was constructed with significant (p<0.05) variables from a univariate analysis. Results 189 patients were scored using TDS. 69 (36.5%) suffered from hyperthyroidism, 42 (22.2%) from Hashimoto’s, 34 (18.0%) from thyroid cancer and 36 (19.0%) from multinodular goiter. Among hyperthyroid patients, the DT group had a greater number preoperatively treated with Lugol’s potassium iodide (81.6% DT vs. 58.1% NDT, p=0.032), presence of ophthalmopathy (31.6% DT vs. 9.7% NDT, p=0.028) and presence of (>4 IU/mL) anti-thyroglobulin antibodies (34.2% DT vs. 12.9% NDT, p=0.05). Using multivariate analysis, hyperthyroidism (OR 4.35, 95% CI 1.23–15.36, p=0.02), presence of anti-thyroglobulin antibody (OR 3.51, 95% CI 1.28–9.66, p=0.015), and high (>150 ng/mL) thyroglobulin (OR 2.61, 95% CI 1.06–6.42, p=0.037) were independently associated with DT. Conclusion Using TDS, we demonstrated that a diagnosis of hyperthyroidism, pre-operative elevation of serum thyroglobulin and anti-thyroglobulin antibodies are associated with DT. This tool can assist surgeons in counseling patients regarding personalized operative risk and improve OR scheduling.

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Section: Discussionmentioning

confidence: 99%

Identifying predictors of a difficult thyroidectomy

Mok

Oltmann

Chen

et al. 2014

Journal of Surgical Research

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“…In an effort to improve patient outcomes and increase centralization, thyroid surgery has been increasingly performed by high-volume surgeons (4,5,7). With economic pressures in recent years, there has also been a shift to perform more outpatient thyroid procedures, especially in healthy patients with benign disease or those requiring only thyroid lobectomy (1,3,5,6,(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

National Trends and Factors Associated with Hospital Costs Following Thyroid Surgery

Biron

Bang

Farwell

et al. 2015

Thyroid

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According to the NIS data set, costs associated with hospitalization after thyroid surgery increased markedly from 2003 to 2011. This increase could be in part due to a growing proportion of sicker patients undergoing more extensive surgery, but a number of confounders in this study limit the conclusions. Further analysis of factors that could be associated with the rising costs of inpatient thyroid surgery should be undertaken.

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“…Use of clinical pathways in endocrine surgery improves resource utilization and increases the value of care delivered. 12,13 Kulkarni et al 12 demonstrated that clinical pathways decreased duration of stay, costs, and charges for endocrine procedures without impacting quality of care adversely. From the same academic endocrine surgery program, Abdulla et al 13 demonstrated that transitioning appropriate operations for lesser risk surgical patients to an outpatient setting decreased cost of care.…”

Section: Discussionmentioning

confidence: 99%