[Length of hospital stay and complications in thyroid surgery. Our experience].
Dipartimento di Chirurgia e Scienze Odontostomatologiche, Università degli Studi di Cagliari, Policlinico Universitario.Chirurgia italiana 03/2007; 59(2):149-53.
Length of hospital stays for thyroid surgery has decreased significantly over the last years. Hypoparathyroidism is one of the main obstacles to short-stay hospitalization. The aim of this study was to evaluate length of hospital stay in our experience, its relationship with complications observed and feasibility of short-stay hospitalization regimen. Between September 2002 and December 2005, 932 patients underwent total thyroidectomy in our institution. Serum calcium and phosphorus values were obtained at 6 hours after operation and on postoperative day 1 and 2. Discharge was possible on the morning of the first postoperative day in 2 patients (0.2%), the second day in 687 (73.7%), third day in 167 (17.9%), fourth in 44 (4.7%), fifth in 22 (2.4%), after the fifth in 10 (1.1%). Complications observed were hypoparathyroidism in 393 patients (42.1%), neck hematoma in 12 (1.3%), bilateral recurrent nerve palsy in 5 (0.5%), unilateral recurrent nerve palsy in 4 (0.4%), glottic hemorrhagic edema in 1 (0.1%) and foreign body granuloma and/or fistula in 5 (0.5%). Hypocalcemia was observed on post-operative day 1 in 338 patients (86%), on day 2 in 50 (12.72%) and on day 3 in 5 (1.27%). Serum calcium and phosphorus determination 6 hours after operation and on postoperative day 1 permits an early treatment of hypocalcemia and to shorten length of hospital stay. A normal serum calcium level on postoperative day 1 lets suppose an easy discharge on the second. Earlier discharge is to be reserved to selected patients and not always meets their favour.
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ABSTRACT: We retrospectively evaluated a series of patients who underwent minimally invasive video-assisted thyroidectomy (MIVAT) to define its advantages or disadvantages. Between May 2005 and March 2008, 68 patients underwent MIVAT. Sixty-nine patients who underwent conventional thyroidectomy (CT) during the period before the introduction of the MIVAT technique in our department-chosen with the same inclusion criteria used for MIVAT-served as matched controls. The eligibility criteria for both groups was thyroid nodules < or = 35 mm, thyroid volume < 25 ml, no thyroiditis, and no previous surgery. Forty-five MIVAT and 43 CT patients underwent hemithyroidectomy. Twenty-three MIVAT and 26 CT patients underwent total thyroidectomy. No differences were found in terms of complications, operative time, and radicality of the procedure. Patients who underwent MIVAT experienced significantly less pain, better cosmetic results, and shorter hospital stay than patients who underwent conventional surgery The MIVAT technique, in selected patients, seems to be a valid option for thyroidectomy and even preferable to conventional surgery because of its significant advantages, especially in terms of cosmetic results, postoperative pain, and postoperative recovery.
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ABSTRACT: The aim of our study was to evaluate the incidence and timing of postoperative bleeding and to identify the potential aetiological factors of cervical hematomas complicating thyroid surgery. Between September 2002 and December 2009, 2559 patients were operated on in Department of Surgery, University Hospital of Cagliari. 2257 total thyroidectomies, 191 total thyroidectomies associated to lymphadenectomy, 83 total thyroidectomies associated to parathyroidectomy, 24 thyroid lobectomies and 4 lobectomies associated to parathyroidectomy were performed. 35 Patients (1.36%) developed a postoperative hematoma, 32 of whom (1.25%) needed a surgical revision. Male sex seemed to have a greater risk: 13 men (2.79% of all males) vs. 19 women (0.90% of all female cases) had to undergo haemostasis revision (p = 0.00204). 16 of 32 patients (50%) who underwent surgical revision had hypertension; incidence of hematoma was 2.09% in patients with hypertension and 0.89% in patients without it (p = 0.02112). It is generally difficult to predict which patients are at risk for the development of a hematoma after thyroid surgery. The most intense postoperative monitoring is necessary during the first six hours but hematomas occurring after are not rare. Postoperative hematoma remains a rare but potentially life-threatening complication. Early recognition with immediate intervention is the key to the management of this complication. Because of the possibly long interval between the initial operation and the hematoma development, ambulatory and one-day thyroid surgery is not advisable.
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ABSTRACT: To develop statistical prediction tools to select patients for short-stay thyroidectomy based on dynamic quantification of individual risk for postoperative hypocalcemia. Clinical and biochemical factors that could influence postoperative calcium levels were analyzed. A multivariable logistic regression model was used to study the predictive ability of each variable for hypocalcemia. A step-down model reduction selection method was used to rank the predictors according to their predictive accuracy. Memorial Sloan Kettering Cancer Center. A test population of 393 patients who met our inclusion criteria and who underwent total thyroidectomy at Memorial Sloan Kettering Cancer Center in the year 2008 made up the modeling data set, 116 of whom developed biochemical hypocalcemia postoperatively (29.5%). The nomograms were validated on an independent data set consisting of 296 selected patients who underwent total thyroidectomy during the year 2005, using the same selection criteria for inclusion as those for the modeling data set. The 8 predictors with the highest predictive accuracy were selected to generate a nomogram, which was validated both internally and externally using an independent data set. A second nomogram was developed for assessing the probability of a patient stay of 24 hours or shorter, based on preoperative and intraoperative factors. The 8 variables of highest predictive value were age, sex, medications, history of cancer, preoperative serum calcium level, creatinine concentration, central neck dissection, and alkaline phosphatase levels. A nomogram was created based on the final parsimonious model. The nomogram had excellent accuracy (concordance index of 74.6%) and scored high on internal validation tests. The concordance index of the second nomogram for predicting the likelihood of discharge from the hospital within 24 hours was 70%. We have produced a set of nomograms that can dynamically quantify the risk of postthyroidectomy hypocalcemia and prolonged hospital stay based on preoperative clinical and biochemical variables and intraoperative surgical variables.
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