Safety of Same-Day Thyroidectomy: Meta-analysis and Systematic Review

Khadra, Helmi; Mohamed, Salah Eldin; Hu, Tian; Kandil, Emad

doi:10.1016/j.jss.2013.11.802

Cited by 8 publications

(12 citation statements)

References 5 publications

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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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Section: Discussionsupporting

confidence: 67%

Type I thyroplasty: A safe outpatient procedure

2018

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“…There appears to be a pattern in the literature showing that a higher complications rate is associated with overnight stays compared to same-day surgeries. [8][9][10] According to the American College of Surgeons National Surgical Quality Improvement Program registry, outpatient thyroidectomy surgeries had decreased odds of 30-day hospital readmission, which persisted even after the adjustment of preoperative and postoperative variables. The inference in these papers in general may not merely reflect a higher rate of complications in the inpatient groups in itself, as it is probably subjected to an expected selection bias (namely, probable allocation of high-risk patients as inpatients), but it may serve as a proxy for determining that outpatient thyroid surgeries carry at least a non-inferiority margin of safety that cannot be overlooked, especially with proper profiling of eligible cases in the hands of experienced surgeons.…”

Section: Characteristicmentioning

confidence: 99%

Safety and cost-effectiveness of outpatient thyroidectomy

Alessa

Al‐Angari

Jomah

et al. 2021

SMJ

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To investigate the safety and cost-effectiveness of outpatient thyroidectomy and provide a systematic postoperative protocol for safe discharge. Methods: In this retrospective review, the medical records of all patients who underwent total, hemi, or completion thyroidectomy from July 2017 to April 2019 at 2 tertiary care hospitals were reviewed. Multivariable analysis was performed on the potential predictors of postoperative complications. Healthcare costs were calculated by the type of admission based on the average costs at the 2 centers. Results: One hundred twenty-two patients were enrolled in this study. The majority of cases were in the outpatient group (n=76, 62.3%). Total Original Article thyroidectomy was the most prevalent type of surgery (n=90, 73.7%). There were a total of 20 complications in 18 patients (inpatient=9 versus [vs.] outpatient=9). No cases of cervical hematoma or bilateral vocal cord paralysis were encountered. No significant difference was found between the type of admission (outpatient vs. inpatient) and postsurgical complications (p=0.24). The multivariable regression model retained significance for male gender and American Society of Anesthesiologists Classification III as potential predictors of postoperative complications. Healthcare costs would be reduced by at least 15.5% with the implementation of outpatient surgery. Conclusion: Outpatient thyroidectomy is as safe as inpatient thyroidectomy given the proper selection of cases. We project cost containment of over $711 thousand per 1,000 cases for outpatient thyroid surgeries.

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“…The most common and most important complications of thyroidectomy are recurrent laryngeal nerve palsy, hypocalcemia and hematoma. A meta-analysis and systematic review of 14 studies and 10,478 patients published in 2017; 0-4% of transient recurrent laryngeal nerve paralysis, 0-2% recurrent laryngeal nerve paralysis, 1-21% transient hypocalcemia, 0-2% hematoma and 0-26% total complication rates have been reported [29]. In our study, all complications were examined; 24 (6.6%) of patients had transient hypocalcemia, 1 (0.3%) permanent hypocalcemia, 21 (5.8%) unilateral transient vocal cord paralysis, 1 (0.3%) unilateral permanent vocal cord paralysis, 15 (4.1%) seroma, 1 (0.3%) hemorrhage and 4 (1.1%) had wound infection and were similar to the literature.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, all complications were examined; 24 (6.6%) of patients had transient hypocalcemia, 1 (0.3%) permanent hypocalcemia, 21 (5.8%) unilateral transient vocal cord paralysis, 1 (0.3%) unilateral permanent vocal cord paralysis, 15 (4.1%) seroma, 1 (0.3%) hemorrhage and 4 (1.1%) had wound infection and were similar to the literature. In many studies in the literature, more complication rates have been reported in relapses and re-operations due to cancer diagnosis [29][30][31].…”

Section: Discussionmentioning

confidence: 99%

Incidental thyroid cancer in patients undergoing surgery for benign multinodular goitre: A retrospective clinical study

zpek¹,

Topal²

2019

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Safety of Same-Day Thyroidectomy: Meta-analysis and Systematic Review

Cited by 8 publications

References 5 publications

Type I thyroplasty: A safe outpatient procedure

Type I thyroplasty: A safe outpatient procedure

Safety and cost-effectiveness of outpatient thyroidectomy

Incidental thyroid cancer in patients undergoing surgery for benign multinodular goitre: A retrospective clinical study

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