Safety of outpatient thyroidectomy: Review of the American College of Surgeons National Surgical Quality Improvement Program

McLaughlin, Eamon J.; Brant, Jason A.; Bur, Andrés M.; Fischer, John P.; Chen, Jinbo; Cannady, Steven B.; Chalian, Ara A.; Newman, Jason G.

doi:10.1002/lary.26934

Cited by 35 publications

(52 citation statements)

References 21 publications

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“…11 The studies on outpatient thyroidectomies are more extensive and report similar results in which the outpatient cohort have significantly reduced rates of complications. [9][10][11] Our findings, therefore, support the argument that outpatient parotidectomies are at least as safe as inpatient parotidectomies in selected patients. Although there are potential liabilities to discharging patients the same day as their operation, there are also risks associated with longer hospital stays, as may be evidenced by this study.…”

Section: Discussionsupporting

confidence: 83%

“…Another study at the Fallon Clinic (Worcester, MA) similarly reported low complication rates and modest savings from same‐day parotidectomies . The studies on outpatient thyroidectomies are more extensive and report similar results in which the outpatient cohort have significantly reduced rates of complications . Our findings, therefore, support the argument that outpatient parotidectomies are at least as safe as inpatient parotidectomies in selected patients.…”

Section: Discussionsupporting

confidence: 79%

“…Studies have established the safety of many otolaryngologic procedures in the outpatient setting, including thyroidectomies, sinonasal surgeries, adenotonsillectomies, and pediatric procedures . Parotidectomies, like thyroidectomies, were once only performed in the inpatient setting but are now commonly conducted as ambulatory procedures.…”

Section: Introductionmentioning

confidence: 99%

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Outpatient versus inpatient parotidectomy: Comparison of postoperative complication rates

et al. 2018

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Objectives Parotidectomies have become a common outpatient procedure, but their impact on postoperative complications as compared to inpatient procedures has not been evaluated in a multi‐institutional study. Study Design The aim of this retrospective analysis was to evaluate the differences in outcomes using a standardized cohort of patients undergoing outpatient or inpatient parotidectomies. Methods The National Surgical Quality Improvement Program database was queried for parotidectomies between 2005 and 2014. Univariate analyses were conducted to compare the outpatient and inpatient cohorts. A propensity‐matching algorithm was used to ensure equal distribution of demographics and preoperative comorbidities. Results Among the 4,368 parotidectomies examined, 2,915 (66.7%) were outpatient and 1,453 (33.3%) were inpatient. In the unmatched analysis, the inpatient group had higher rates of smokers (P = < 0.001), hypertension (P = 0.003), and disseminated cancer (P = 0.014). The outpatient group had higher rates of patients under age 40 years (P = 0.015), females (P = 0.016), and American Society of Anesthesiology class 1 and 2 (P = < 0.001). The total work relative value units (RVUs) were 17.01 ± 3.44 for the inpatient cohort and 16.19 ± 3.70 for the outpatient cohort (P = < 0.001). Following propensity matching, 1,352 cases were selected for each cohort, with no significant differences in comorbidities. Total work RVU after matching was 16.90 ± 3.47 for the inpatient group and 16.75 ± 3.44 for the outpatient group (P = .235). The matched inpatient cohort had increased rates of surgical complications (3.1% vs. 1.8%, P = 0.033), pneumonia (0.5% vs. 0.0%, P = 0.016), and overall complications (4.5% vs. 2.6%, P = 0.009). Conclusion Outpatient parotidectomies are associated with similar as well as decreased complication rates as compared to inpatient parotidectomies. Level of Evidence 4 Laryngoscope, 129:655–661, 2019

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 79%

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Outpatient versus inpatient parotidectomy: Comparison of postoperative complication rates

et al. 2018

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“…These data compare favorably to the literature on outpatient thyroidectomy, with complication rates of 5% to 12% reported for patients undergoing hemi or total thyroidectomy, and demonstrating that when patients are carefully selected, the majority can be managed on an outpatient basis …”

Section: Discussionsupporting

confidence: 67%

Type I thyroplasty: A safe outpatient procedure

2018

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Objectives/Hypothesis: Overnight hospitalization is routinely advocated following type I thyroplasty (TP) because of concerns for airway compromise. Hospitalization increases cost and patient inconvenience, and may not necessarily be appropriate. This study evaluated complications following surgery and identified predictors for same to assess which patients benefit most from hospitalization.Study Design: Retrospective chart review.Methods: A study was conducted on patients who underwent TP with or without arytenoid repositioning procedures between June 2008 and March 2017. The demographic data of the subjects, characteristics, etiology of glottic insufficiency, interventions performed, and subsequent complications were evaluated.Results: Of 147 patients reviewed, 100 underwent TP alone, 41 underwent TP with arytenoid adduction, and six patients underwent TP with adduction arytenopexy. Iatrogenic vocal fold paralysis was the most common indication. Major complications, which included transient airway compromise and hematoma requiring reoperation, occurred in 7% of patients. Revision surgery and thyroplasty combined with arytenoid repositioning maneuvers were associated with increased risk of major complications.Conclusions: In general, TP is a safe procedure, with a major complication rate that is lower than that of outpatient thyroidectomy. Overnight hospitalization should be considered in patients undergoing revision surgery and in those requiring concurrent arytenoid repositioning procedures.

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“…Thyroidectomy is a more common procedure than parathyroidectomy, although with similar safety profiles, and several recent publications have determined thyroidectomy to be a safe outpatient procedure. 15,16 McLaughlin et al 15 performed an analysis of 76,604 cases of partial and total thyroidectomy from NSQIP from 2012 to 2014 and identified a 1.4% 30-day readmission rate and 1.9% reoperation rate. Over time, there was a positive trend in the number of outpatient procedures.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Readmission and Reoperation in Patients Undergoing Parathyroidectomy for Primary Hyperparathyroidism

Roche

Brant²,

Chai

2018

Otolaryngol.--head neck surg.

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Objective Identify risk factors for 30-day reoperation and readmission after parathyroidectomy for primary hyperparathyroidism. Study Design Retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012 through 2014. Subjects and Methods Patients undergoing parathyroidectomy and parathyroid reexploration for primary hyperparathyroidism. Univariate and multivariate analyses were conducted to determine risk factors for reoperation and readmission. Results Of the 9439 patients who underwent parathyroidectomy, 72 patients underwent 1 reoperation in the first 30 days after surgery, and 8 patients underwent 2 reoperations. The most common reasons were hematoma (25%) and persistent hyperparathyroidism (15.9%). Risk factors included smoking (odds ratio [OR], 1.86; 95% confidence interval [CI], 0.97-3.31), insulin-dependent diabetes (OR, 2.38; 95% CI, 1.02-4.86), and history of bleeding disorder (OR, 3.95; 95% CI, 1.48-8.79). In total, 182 (1.9%) patients were readmitted within 30 days of surgery; the most common cause was hypocalcemia (17.0%). Risk factors included operative time (hours) (OR, 1.3; 95% CI, 1.1-1.5), insulin-dependent diabetes mellitus (OR, 2.01; 95% CI, 1.2-3.3), dyspnea with moderate exertion (OR, 5.77; 95% CI, 0.86-14.67), and age (decade) (OR, 1.16; 95% CI, 1.02-1.32). Patients undergoing outpatient surgery were less likely to be readmitted (OR, 0.49; 95% CI, 0.35-0.69) or undergo reoperation (OR, 0.44; 95% CI, 0.27-0.73). Conclusions Thirty-day reoperation rate after parathyroidectomy was low and most commonly occurred due to hematoma. Risk factors for readmission were multifactorial and associated with perioperative factors, patient factors, and medical comorbidities. Preoperative counseling for patients at increased risk of readmission and reoperation may decrease these rates.

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Safety of outpatient thyroidectomy: Review of the American College of Surgeons National Surgical Quality Improvement Program

Abstract: 2c. Laryngoscope, 128:1249-1254, 2018.

Cited by 35 publications

References 21 publications

Outpatient versus inpatient parotidectomy: Comparison of postoperative complication rates

Outpatient versus inpatient parotidectomy: Comparison of postoperative complication rates

Type I thyroplasty: A safe outpatient procedure

Predictors of Readmission and Reoperation in Patients Undergoing Parathyroidectomy for Primary Hyperparathyroidism

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