Outpatient and short‐stay thyroid surgery

Abstract

With the realization that simple thyroid procedures had a very low rate of complication and that patients often seemed well enough to go home from the recovery room, we began performing them in an ambulatory surgery setting. We review here 134 consecutive thyroid procedures performed at Columbia Presbyterian Medical Center between July 1987 and July 1989. Patients undergoing reoperation, neck dissection, sternal splits, or other concomitant procedures were excluded. There were 105 women and 29 men with an average age of 47 years. Fifty percent of the operations were performed for benign disease, although the most common diagnosis was papillary cancer (44%). Twenty-one operations (16%) were performed under local anesthesia. Most patients underwent surgery in our ambulatory surgery unit and 76 were discharged the day of surgery. Of these patients, 21 underwent total thyroidectomy, 13 subtotal thyroidectomy, and 42 simple thyroid lobectomy. Of the 58 patients who were admitted, 53 were discharged on the day following surgery. The average length of stay was 0.49 days. Extensive pre- and postoperative teaching was given regarding the signs and symptoms associated with the complications of thyroid surgery. All patients were felt to be reliable and capable of understanding the procedure and of complying with the postoperative plans. Postoperative complications included 8 patients (6%) with transient hypocalcemia and 1 patient (0.75%) with permanent unilateral recurrent laryngeal nerve paralysis. All complications occurred in patients who underwent total thyroidectomies. No patient had a postoperative complication requiring reoperation or readmission. We conclude that by using specific selection criteria, thyroid lobectomies and subtotal thyroidectomies can be performed safely in an ambulatory surgery setting without increase in morbidity or mortality.

Our experience of 200 cases of thyroid surgery under local anaesthesia versus general anaesthesia

“…3 Local anaesthesia is economical and simpler to administer and thus fulfils the requirements for Day care surgery. [5][6][7] A few surgeons in the west are carrying out thyroid surgery exclusively under local anaesthesia and cervical blocks after careful patient selection and propagating the effectiveness of such approach. 8 We attempt to analyse the characteristics of patients undergoing surgery under local and general anaesthesia and evaluate the outcome measures in terms of the cost effectiveness, hospital stay and complications in this retrospective Cohort study.…”

Hipocalcemia e hipoparatireoidismo clínico após tireoidectomia total

“…A sintomatologia é menos intensa ou ausente e, na maioria dos casos, desaparece em até 72 horas 23,25 . O hipoparatireoidismo transitório após tireoidectomias totais ocorre em até 87% dos casos e o permanente em até 33% [2][3][4][7][8][9][10][11][12][13]15,16,[26][27][28] . Neste estudo ocorreu em 37% dos casos no 1 o tipo e em 18% no 2 o , o que está de acordo com os dados de literatura.…”

“…Nos últimos 10 anos vários autores relataram taxas de hipocalcemia temporária entre 6 e 87% 2,3,4,7-13 . A hipocalcemia permanente ocorre entre 0 e 33% nos casos de tireoidectomia total, a maioria assintomáticos 2,3,4,[7][8][9][10][11][12][13][14][15][16] . O diagnóstico pós-operatório é possível por meios clínicos e laboratoriais.…”

“…Hipocalcemia após tireoidectomia total é uma complicação comum e ocorre entre 0 e 87% dos casos [1][2][3][4][5][6][7] . Nos últimos 10 anos vários autores relataram taxas de hipocalcemia temporária entre 6 e 87% 2,3,4,[7][8][9][10][11][12][13] .…”

Early discharge after total thyroidectomy: a retrospective feasibility study

“…Thyroid surgery was no exception. In Italy thyroid surgery is performed on an inpatient basis, mostly consisting in short admissions in week surgery departments with discharge to 48-72 hours after surgery, but several were the contributions in the literature in favour of an early discharge surgery (3)(4)(5)(6)(7), and some recommend at least an overnight stay (8,9). In the United States for years outpatient surgery with discharge on the same day of surgery has had a broad appeal and the rate of thyroid surgical procedures on an outpatient basis over the past 10 years has risen to 39% (10), thanks to the use of outstanding centers.…”