Ambulatory thyroidectomy: an anesthesiologist’s perspective

Abstract

Thyroidectomy has been performed on an inpatient basis because of concerns regarding postoperative complications. These include cervical hematoma, bilateral recurrent laryngeal nerve injury and symptomatic hypocalcemia. We have reviewed the current available evidence and aimed to collate published data to generate incidence of the important complications. We performed a literature search of Medline, EMBASE and the Cochrane database of randomized trials. One hundred sixty papers were included. Twenty-one papers fulfilled inclusion criteria. Thirty thousand four hundred fifty-three day-case thyroid procedures were included. Ten papers were prospective and 11 retrospective. The incidences of complications were permanent vocal cord paralysis 7/30259 (0.02%), temporary hypocalcemia 129/4444 (2.9%), permanent hypocalcemia 405/29203 (1.39%), cervical hematoma 145/30288 (0.48%) and readmission rate 105/29609 (0.35%). Analysis of cervical hematoma data demonstrated that in only 3/14 cases the hematoma presented as an inpatient, and in the remaining 11/14, it occurred late, with a range of 2–9 days. There is a paucity of data relating to anesthetic techniques associated with ambulatory thyroidectomy. Cost comparison between outpatient and inpatient thyroidectomy was reported in three papers. Cost difference ranged from $676 to $2474 with a mean saving of $1301 with ambulatory thyroidectomy. There is a body of evidence that suggests that ambulatory thyroidectomy in the hands of experienced operating teams within an appropriate setting can be performed with acceptable risk profile. In most circumstances, this will be limited to hemithyroidectomies to reduce or avoid the potential for additional morbidity. We have found little evidence to support the use of one anesthetic technique over another. The rates of hospital admission and readmission related to anesthetic factors appear to be low and predominantly related to pain and postoperative nausea and vomiting. A balanced anesthetic technique incorporating appropriate analgesic and antiemetic regimens is essential to avoid unnecessary hospital admission/readmission.

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

“…To improve the comfort of patients, anesthesiologists can effectively reduce the incidence of postoperative PONV by rationally selecting drugs and anesthesia methods during the operation. Studies have shown that moderate use of dexmedetomidine in thyroidectomy can reduce the use of postoperative anesthesia, which will help patients’ postoperative analgesia ( 22 , 23 ). However, the use of dexmedetomidine during overnight thyroidectomy did not reduce the incidence of PONV at 24 hours in postoperation (p=0.355) ( 24 ).…”

The ambulatory transoral endoscopic thyroidectomy vestibular approach is safe and economical for patients with thyroid nodules

“…Steckler first introduced ambulatory thyroid surgery in 1986 (5). In recent years, improvements in surgical techniques have decreased the incidence of complications in thyroid surgery (6), and the use of ambulatory thyroid surgery has gradually increased. Many international reports have shown the safety and economic benefits of ambulatory thyroid surgery (7,8).…”