Same-day thyroidectomy program: Eligibility and safety evaluation

Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI.
Surgery (Impact Factor: 3.38). 12/2012; 152(6):1133-41. DOI: 10.1016/j.surg.2012.08.033
Source: PubMed


Same-day thyroidectomy has not gained widespread acceptance owing to concerns of life-threatening complications. The aim of this study is to describe a single institution same-day thyroidectomy results.
We included patients who underwent thyroid surgery between 2005 and 2011 by a single surgeon. The outcomes of patients who underwent inpatient (IP) and same-day thyroidectomy were compared. Routine postoperative parathyroid hormone testing for same-day thyroidectomy commenced in 2010, and results were also compared after that date.
Thyroid surgery was performed in 608 patients; 298 (49%) were performed as same-day thyroidectomy. Patients undergoing same-day thyroid lobectomy had similar, low documented complication rate as IP lobectomy. Patients with same-day total thyroidectomy (SDTT) had similar rates of documented transient hypocalcemia and neck hematoma compared with IPs. After 2010, all patients without restrictive underlying comorbidities were scheduled for same-day thyroidectomy unless otherwise specifically requested by the patient. Only 4 (3%) patients scheduled for SDTT were converted to IPs, all without neck complications.
Same-day thyroidectomy is safe and can be routinely performed by experienced surgeons who have low complication rates and a patient support system.

Download full-text


Available from: Haggi Mazeh, Oct 07, 2015
30 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Thyroid and parathyroid procedures historically have been viewed as inpatient procedures. Because of the advancements in surgical techniques, these procedures were transferred from the inpatient operating room (OR) to the outpatient OR at a single academic institution approximately 7 y ago. The goal of this study was to determine whether this change has decreased turnover times and maximized OR utilization. Methods: We performed a retrospective review of 707 patients undergoing thyroid (34%) and parathyroid (66%) procedures by a single surgeon at our academic institution between 2005 and 2008. Inpatient and outpatient groups were compared using Student t-test, chi-square test, or the Kruskal-Wallis test where appropriate. Multiple regression analysis was used to determine how patient and hospital factors influenced turnover times. Results: Turnover times were significantly lower in the outpatient OR (mean 18 ± 0.7 min) when compared with the inpatient OR (mean 36 ± 1.4 min) (P < 0.001). When compared by type of procedure, all turnover times remained significantly lower in the outpatient OR. Patients in both ORs were similar in age, gender, and comorbidities. However, inpatients had a higher mean American Society of Anesthesiologists score (2.30 versus 2.13, P < 0.001) and were more likely to have an operative indication of cancer (23.1% versus 9.2%, P < 0.001). Using multiple regression, the inpatient OR remained highly significantly associated with higher turnover times when controlling for these small differences (P < 0.001). Conclusions: Endocrine procedures performed in the outpatient OR have significantly faster turnover times leading to cost savings and greater OR utilization for hospitals.
    Journal of Surgical Research 05/2013; 184(1). DOI:10.1016/j.jss.2013.04.038 · 1.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: The primary goals of this interdisciplinary consensus statement are to define the eligibility criteria for outpatient thyroidectomy and to explore preoperative, intraoperative, and postoperative factors that should be considered in order to optimize the safe and efficient performance of ambulatory surgery. Summary: A series of criteria was developed that may represent relative contraindications to outpatient thyroidectomy, and these fell into the following broad categories: clinical, social, and procedural issues. Intraoperative factors that bear consideration are enumerated, and include choice of anesthesia, use of nerve monitoring, hemostasis, management of the parathyroid glands, wound closure, and extubation. Importantly, postoperative factors are described at length, including suggested discharge criteria and recognition of complications, especially bleeding, airway distress, and hypocalcemia. Conclusions: Outpatient thyroidectomy may be undertaken safely in a carefully selected patient population provided that certain precautionary measures are taken to maximize communication and minimize the likelihood of complications.
    Thyroid: official journal of the American Thyroid Association 06/2013; 23(10). DOI:10.1089/thy.2013.0049 · 4.49 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To provide population-based estimates of trends in thyroid nodule fine-needle aspirations (FNA) and operative volumes, we used multiple claims databases to quantify rates of these procedures and their association with the increasing incidence of thyroid cancer in the United States. Private and public insurance claims databases were used to estimate procedure volumes from 2006 to 2011. Rates of FNA and thyroid operations related to thyroid nodules were defined by CPT4 codes associated with International Classification of Diseases, Ninth Revision Clinical Modification codes for nontoxic uni- or multinodular goiter and thyroid neoplasms. Use of thyroid FNA more than doubled during the 5-year study period (16% annual growth). The number of thyroid operations performed for thyroid nodules increased by 31%. Total thyroidectomies increased by 12% per year, whereas lobectomies increased only 1% per year. In 2011, total thyroidectomies accounted for more than half (56%) of the operations for thyroid neoplasms in the United States. Thyroid operations became increasingly (62%) outpatient procedures. Thyroid FNA and operative procedures have increased rapidly in the United States, with an associated increase in the incidence of thyroid cancer. The more substantial increase in number of total versus partial thyroid resections suggests that patients undergoing thyroid operation are perceived to have a greater risk of cancer as determined by preoperative assessments, but this trend could also increase detection of incidental microcarcinomas.
    Surgery 10/2013; 154(6). DOI:10.1016/j.surg.2013.07.006 · 3.38 Impact Factor
Show more