Outpatient Thyroidectomy Found to Be Safe

Same-day outpatient thyroid surgery based on careful patient selection coupled with prophylactic calcium supplementation is both safe and desirable, according to a new study.

Researchers at the Medical College of Georgia (MCG, Augusta, USA) and the Augusta Veterans Administration Hospital (GA, USA) conducted a prospective, non-randomized study of 91 consecutive patients undergoing thyroidectomy between December 2004 and October 2005. Fifteen patients were male, 76 patients were female, and the mean age was 46.3 ± 14.7 years. Patients were segregated into two groups on the basis of admission status (outpatient or inpatient). Fifty-two (57%) were managed on an outpatient basis, 26 were observed under a 23-hour status, and 13 were admitted.

A number of surgical techniques were used, including a Kocher incision, minimally invasive thyroid surgery with access to the thyroid compartment, and endoscopic thyroidectomy. Following surgery, outpatients were assessed and discharged once they were ambulatory, tolerating a diet, and managing their pain with oral medications. All patients who underwent total or complete thyroidectomy were placed on a prophylactic calcium supplementation regimen consisting of a three-week taper of oral calcium carbonate. Patients were seen for follow-up within one to two weeks after surgery and subsequently as clinically indicated. The results were presented at the 110th annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery Foundation, held in September 2006 in Toronto (Canada).

"Despite cost-savings achieved with outpatient surgery, the real benefits of pursuing ambulatory thyroidectomy were not financial. The peripheral benefits of outpatient surgery include the advantages of convalescence in the home environment (which is appealing to many individuals) and minimizing exposure to the organisms which populate most medical centers. On the other hand, patients for whom inpatient hospitalization should still be considered include medically infirm individuals, those undergoing concomitant procedures that would normally require admission, or those with known blood disease,” concluded David J. Terris M.D., and colleagues at the Medical College of Georgia.

Despite the trend toward outpatient surgery, surgeons who perform thyroid and parathyroid surgery have been reluctant to adopt this approach primarily out of concern for bleeding and the fear of life-threatening hypocalcemia, or low blood calcium level.



Related Links:
Medical College of Georgia
Augusta Veterans Administration Hospital