Outpatient versus observation/inpatient parotidectomy: patient factors and perioperative complications

Abstract

The objective of this manuscript is to review a single institution's experience with superficial or total parotidectomy in outpatient and observation/inpatient groups. All patients who underwent superficial or total parotidectomy between 2009 and 2015 were identified. Patients were excluded if they had undergone concurrent surgery such as neck dissection, had prior radiation treatment or surgery at the operative site. Main outcomes were perioperative complications in both groups. 215 consecutive patients were included in the study, 116 (54%) patients in the inpatient group and 99 (46%) in the outpatient group. Aside from a higher observed rate of cardiac disease in the outpatient group (24.2 vs. 11.2%, p = 0.014) and larger mean body mass index (BMI) in the inpatient group (32.448 vs. 30.034, p = 0.017), there were no significant differences for age, sex or smoking status. Average operative time differed between groups with 2 h 42 min for inpatients and 2 h 18 min for outpatients (p < 0.001). There were 26 complications in the inpatient group (22.4%, including two hematomas) and 8 in the outpatient group (8.1%). The rate of seroma/sialocele formation was significantly higher in the inpatient group at 15.5% (n = 18) compared with the outpatient group at 3% (n = 3, p = 0.001). Our study shows that parotidectomy, superficial or total, was performed safely as an outpatient procedure without significant increase in complications when compared to patients observed for at least one night after surgery.

Outpatient versus inpatient parotidectomy: Comparison of postoperative complication rates

“…One single-institutional analysis comparing superficial and total parotidectomies performed as an outpatient versus inpatient procedure found comparatively low rates of procedure-specific complications in the outpatient cohort, concluding that these procedures can be performed safely without overnight observation. 15 Another study at the Fallon Clinic (Worcester, MA) similarly reported low complication rates and modest savings from same-day parotidectomies. 11 The studies on outpatient thyroidectomies are more extensive and report similar results in which the outpatient cohort have significantly reduced rates of complications.…”

“…This analysis indicates no differences in patient readmissions following inpatient or outpatient parotidectomy, along with lower rates of reoperation succeeding outpatient parotidectomies prior to matched analysis (Table V). Low rates of readmission and reoperation after ambulatory parotidectomies have been demonstrated in smaller studies, 15,17 although patients with more comorbidities are more likely to be inpatient and thus may be more likely to require a reoperation. The literature emphasizes the importance of patient competency for postoperative care and frequent follow-up after outpatient surgery, 4 which may be paramount to preventing readmissions and reoperations.…”

“…The comparison of outpatient procedures to inpatient procedures has highlighted criteria for patient selection as one of the most important factors in maximizing success in the outpatient setting. [4][5][6][7][8][9]15 There currently are no guidelines delineating which patients undergoing parotidectomies should be considered for outpatient operations. Studies on other head and neck procedures, such as thyroidectomies, have paved the way for associations to outline inclusion and exclusion criteria for those procedures.…”

“…Previous studies are limited to single institution experiences. [15][16][17][18] Furthermore, no guidelines on patient selection exist for same-day parotidectomies as they do for same-day thyroidectomies. 19 Investigation is necessary to ensure that outpatient parotidectomies can safely be performed and to elucidate those patient characteristics that necessitate overnight hospital stay.…”

Outpatient vs inpatient parotidectomy: Systematic review and meta‐analysis

“…Study characteristics along with patient demographics are summarized in Table 1. Eleven studies were retrospective cohort studies 7,25‐32,34,35 . Two prospective cohort studies were included 16,33 .…”