Outpatient Thyroid Surgery in a Low‐Surgical Volume Hospital

Abstract

Outpatient thyroid surgery can be performed safely in a low-surgical volume center. Reasons for a longer stay include clinical as well as social factors.

Safety of outpatient thyroidectomy: Review of the American College of Surgeons National Surgical Quality Improvement Program

“…Numerous previous smaller studies have demonstrated the safety of outpatient thyroidectomy . However, interpreting the current data on outpatient thyroidectomy needs to be done carefully based on the varying definition of outpatient status.…”

Ambulatory thyroidectomy: an anesthesiologist’s perspective

“…One patient planned for ambulatory thyroidectomy suffered bilateral vocal cord palsy requiring reintubation. This was immediately apparent at extubation 3. One patient, a nursing-home resident, died two days after a total thyroidectomy from a perioperative cardiac event 2…”

“…The complications that have resulted in thyroidectomy remaining predominantly an inpatient procedure have largely been surgical; the risk of airway compromise because of cervical hematoma and bilateral RLN injury and symptomatic hypocalcemia due to inadvertent parathyroid injury or removal 2. Proponents of same-day thyroidectomy believe that these complications can be minimized through robust surgical technique and operative pathways and assessment 2,3. Since the 1990s there have been a small but significant number of authors who have reported same-day thyroidectomy 4,5…”

Early discharge after total thyroidectomy: a retrospective feasibility study

“…Recent improvements in hemostasis (including proliferation of advanced energy devices), widespread implementation of nerve monitoring, and routine postoperative calcium supplementation appear to have decreased these risks (51). The bleeding is usually evident within the first 24 hours after surgery and more frequent in the first 6 postoperative hours, being late hemorrhages rare (8,50,52). Inferior laryngeal nerves palsy also generally arises early, in about 87% of cases, with the appearance of dysphonia within the first 24 hours after surgery, but later onsets are also described, up to 14 days after surgery, in the remaining 13% of cases (53)(54)(55)(56)(57).…”

“…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.…”