Ambulante und kurzzeitstation�re Schilddr�sen- und Nebenschilddr�senchirurgie

Abstract

Outpatient or short-stay thyroid and parathyroid surgery is still uncommon in Germany. Although a substantial number of these operations are performed with low morbidity, nearly zero mortality, and short operation time, some potentially lethal complications, especially postoperative hemorrhage, are strong arguments against liberal shortening of hospital stay. Symptomatic hematomas after thyroid and parathyroid surgery are observed in about 1-2% of cases. They frequently occur during the first 8 h after operation (40%). However, two thirds of these major complications occur later, about 20% of them more than 24 h postoperatively. Therefore, an outpatient procedure cannot be generally recommended. Short-stay (<23 h, overnight) thyroid and parathyroid surgery may be attractive, but this concept requires clear release-criteria and professional outpatient structures. Compared to general anesthesia, local and regional anesthesia did not emerge as helpful to shorten hospital stay. Also, prophylactic calcium supplementation is not recommended to enhance early hospital discharge after bilateral thyroid or parathyroid surgery.

Compartment Pressure Monitoring After Thyroid Surgery: A Possible Method to Detect a Rebleeding

“…Previously risk factors for rebleeding were identified [4–6, 8, 17], but it still remains impossible to predict a rebleeding event [2, 23]. Furthermore, there has never been an objective tool available for an early recognition of this potentially life‐threatening complication.…”

“…3). They were lying down in a supine position at rest (1), coughing (2) and Valsalvaing (3) 3 s. After that, patients were requested to stand upright (4), coughing (5) and Valsalvaing (6) 3 s. At last, patients walked one floor down stairs (7), climbed back up (8) and finally lying down in a supine position (9). The highest pressure value detected in each of these situations was recorded and used for statistical analysis.…”

“…0.6% of these patients develop hypoxic brain damage [1]. The majority of symptomatic hemorrhages (40–56%) occur within 8 h after surgery and 80–85% within 24 h [4, 5].…”

“…Several factors have been identified to increase the risk of postoperative hemorrhage, including patient age, gender, tumor size, lymphatic dissection, bilateral resection, Grave's disease, 3rd goiter and hypertension (systolic blood [ 150 mmHg) [4][5][6][7]. The role of NSAIDs in this context is controversial [8].…”

The safety, benefits and future development of overnight and outpatient thyroidectomy

“…Outpatient thyroidectomy means that the patients are discharged on the same day after their vital signs are stable to return to their homes for rest and recovery. Overnight thyroidectomy was first reported in the literature in 2004 ( 8 ). The most significant difference between overnight thyroidectomy and outpatient thyroidectomy is whether you will spend one night in the hospital after surgery.…”