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Nakanishi H, Wang R, Miangul S, Kim GE, Segun-Omosehin OA, Bourdakos NE, Than CA, Johnson BE, Chen H, Gillis A. Clinical outcomes of outpatient thyroidectomy: A systematic review and single-arm meta-analysis. Am J Surg 2024; 236:115694. [PMID: 38443270 DOI: 10.1016/j.amjsurg.2024.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/25/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND The aim of this meta-analysis is to investigate the safety of outpatient thyroidectomy based on 24-h and same-day discharge criteria. METHODS CENTRAL, Embase, PubMed, and Scopus were searched. A meta-analysis of selected studies was performed. The review was registered prospectively with PROSPERO (CRD42022361134). RESULTS Thirty-one studies met the eligibility criteria, with a total of 74328 patients undergoing thyroidectomy in an outpatient setting based on 24-h discharge criteria. Overall postoperative complications after outpatient thyroidectomies were 5.7% (95%CI: 0.049-0.065; I2 = 97.3%), consisting of hematoma (0.4%; 95%CI: 0.003-0.005; I2 = 83.4%), recurrent laryngeal nerve injury (0.4%; 95%CI: 0.003-0.006; I2 = 93.5%), and hypocalcemia (1.6%; 95%CI: 0.012-0.019; I2 = 93.7%). The rate of readmission was 1.1% (95%CI: 0.007-0.015; I2 = 95.4%). Results were similar for same-day criteria. CONCLUSIONS Our analysis demonstrated that outpatient thyroidectomy is a safe procedure in the management of thyroid disease for selected patients.
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Affiliation(s)
- Hayato Nakanishi
- St George's University of London, London, SW17 0RE, UK; University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus
| | - Rongzhi Wang
- Department of Surgery, University of Alabama at Birmingham. Birmingham, AL, USA
| | - Shahid Miangul
- St George's University of London, London, SW17 0RE, UK; University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus
| | - Grace E Kim
- Division of Emergency Medicine, NorthShore University Health System, Chicago, IL, USA
| | - Omotayo A Segun-Omosehin
- St George's University of London, London, SW17 0RE, UK; University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus
| | - Natalie E Bourdakos
- St George's University of London, London, SW17 0RE, UK; University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus
| | - Christian A Than
- St George's University of London, London, SW17 0RE, UK; University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus; School of Biomedical Sciences, The University of Queensland, St Lucia, 4072, Australia
| | - Benjamin E Johnson
- Division of Surgery, NorthShore University Health System, Chicago, IL, USA
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham. Birmingham, AL, USA
| | - Andrea Gillis
- Department of Surgery, University of Alabama at Birmingham. Birmingham, AL, USA.
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Laskou S, Tsaousi G, Pourzitaki C, Papazisis G, Kesisoglou I, Sapalidis K. Efficacy and Safety of Magnesium Sulfate as an Adjunct to Ropivacaine Wound Infiltration in Thyroid Surgery: A Prospective, Double-Blind, Randomized Controlled Trial. J Clin Med 2024; 13:4499. [PMID: 39124765 PMCID: PMC11313512 DOI: 10.3390/jcm13154499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/18/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objective: Wound infiltration with local anesthetics emerges as a promising modality for postoperative pain alleviation. However, such strategies in neck surgery have not been a well-established practice. To assess wound infiltration with ropivacaine plus magnesium sulfate for pain relief following thyroid surgery. Methods: This prospective, double-blind, randomized study enrolled 68 patients who underwent thyroid surgery. Concerning the solution used for surgical wound infiltration, the study participants were randomly allocated into three groups: (1) 100 mg of ropivacaine (Group R); (2) 100 mg of ropivacaine plus magnesium sulfate 10 mg/kg (Group RMg); and (3) normal saline which served as a placebo (Group P). Pain perception both at rest and at movement, was measured using the Visual Analogue Scale (VAS) at 30 min, as well as at 1, 2, 4, 6, 12, and 24 h postoperatively. The total consumption of analgesics in morphine equivalents was also recorded. Moreover, adverse effects and patient satisfaction were recorded. Cortisol, TNF-α, and IL-6 levels were measured 30 min before infiltration and 6 h and 24 h postoperatively. Results: Demographics and clinical characteristics were similar between the groups. The VAS scores at rest and during movement were significantly lower in the RMg group compared to the saline or ropivacaine groups. Total analgesic consumption was also significantly lower in the RMg group. No operation-, wound-, or infiltration-related adverse effects were recorded in the study groups. Better overall satisfaction was obtained for the RMg group. Conclusions: Ropivacaine plus magnesium sulfate wound infiltration provided better pain control and the analgesic effect was more significant, contributing to effective postoperative analgesia in patients undergoing thyroid surgery.
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Affiliation(s)
- Stiliani Laskou
- 3rd Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 1st St. Kiriakidi Str, 54636 Thessaloniki, Greece; (I.K.); (K.S.)
| | - Georgia Tsaousi
- Clinic of Anesthesiology and Intensive Care, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Chryssa Pourzitaki
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54006 Thessaloniki, Greece; (C.P.); (G.P.)
| | - Georgios Papazisis
- Department of Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54006 Thessaloniki, Greece; (C.P.); (G.P.)
| | - Isaak Kesisoglou
- 3rd Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 1st St. Kiriakidi Str, 54636 Thessaloniki, Greece; (I.K.); (K.S.)
| | - Konstantinos Sapalidis
- 3rd Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 1st St. Kiriakidi Str, 54636 Thessaloniki, Greece; (I.K.); (K.S.)
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July O'Brien K, Naveed A, Patel S, Gallant JN, Rohde S, Belcher RH. Same-Day Discharge for Pediatric Hemithyroidectomy Patients: Evaluating Safety and Barriers to Discharge. Otolaryngol Head Neck Surg 2024; 171:538-545. [PMID: 38494856 DOI: 10.1002/ohn.726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/04/2024] [Accepted: 02/24/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE Hemithyroidectomy is often performed in the pediatric population for indeterminate or benign thyroid nodules. Prior studies confirmed the safety of same-day discharge for adults undergoing hemithyroidectomy or total thyroidectomy, but this has not been studied thoroughly in the pediatric population. Our goal was to determine differences in pediatric patients undergoing hemithyroidectomy who were admitted versus discharged for complications or factors to support same-day discharge. STUDY DESIGN Retrospective cohort. SETTING Pediatric tertiary care hospital. METHODS This was a retrospective study of pediatric patients (0-18 years of age) undergoing hemithyroidectomy at a pediatric tertiary care hospital from 2003 to 2022. Perioperative variables and outcomes were gathered via manual chart review. RESULTS One hundred five pediatric patients who underwent hemithyroidectomy were identified. Ninety (86%) patients were admitted postoperatively, and 15 (14%) were discharged the same day. There were no differences in patient demographics, including age (P = 0.29) distance from the hospital (P = 0.08) or benign versus malignant pathology (P = 0.93). Surgical time in same-day discharges was significantly shorter (P = 0.0001; 138.6 minutes, SD = 66.0) versus admitted patients (204.2 minutes, SD = 48.6) Hemostatic agents were used more in same-day discharges at 53.3% versus 4.5% (P = 0.0001). Perioperative complications occurred in 2 (2.2%) admitted patients compared to none in the same-day discharge (P = 1.0). There were no readmissions within 30 days for same-day discharges. CONCLUSION In pediatric patients undergoing uncomplicated hemithyroidectomy, same-day discharge appears appropriate for those with shorter surgical times and intraoperative use of hemostatic agents with no readmissions or complications in those discharged the same day.
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Affiliation(s)
- Kaitlin July O'Brien
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Abdullah Naveed
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Siddharth Patel
- Department of Otolaryngology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jean-Nicolas Gallant
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah Rohde
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ryan H Belcher
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Pediatric Otolaryngology-Head and Neck Surgery Division, Monroe Carrell Jr. Hospital at Vanderbilt, Nashville, Tennessee, USA
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Kappauf C, Gold B, Gonzalez-Velazquez C, Xing MH, O'Malley QF, Sandler M, Chai RL. Assessing Postoperative Phosphate and Calcium/Phosphate Ratio as Surrogates for Parathyroid Hormone Following Total Thyroidectomy. Otolaryngol Head Neck Surg 2024; 171:54-62. [PMID: 38483034 DOI: 10.1002/ohn.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Evaluate utility of postoperative phosphate and calcium/phosphate ratio (Ca/P) as surrogates for parathyroid hormone (PTH) following total thyroidectomy. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care hospital. METHODS We retrospectively reviewed patients 18 years or older who underwent total thyroidectomy in a tertiary care hospital by a single surgeon from 2015 through 2021. Patients with incomplete data, pre-existing hypoparathyroidism, vitamin D deficiency, or renal failure were excluded. All patients had PTH drawn within 4 hours of surgery and serum calcium, albumin, and phosphate levels on postoperative Day 1. Corrected calcium was used to calculate a Ca/P. Receiver operating characteristic (ROC) curves were generated to compare phosphate level or Ca/P with PTH. Each possible surrogate was assessed relative to PTH cutoffs of less than 5, 10, 15, and 20 pg/mL. A good screening test was defined as having an area under the curve (AUC) greater than 0.8. RESULTS A total of 185 patients underwent total thyroidectomy with 1 fellowship-trained otolaryngologist. Most patients were female (62%), median age 48 years. Most surgeries were performed for cancer (68%). Six (3.2%) patients required IV calcium supplementation and 2 (1.1%) required readmission for symptomatic hypocalcemia. ROC curves comparing phosphate and Ca/P to PTH at the listed cutoffs demonstrated AUC ranging from 0.55 to 0.66 and 0.61 to 0.79, respectively. None met the threshold for a good screening test. CONCLUSION Postoperative phosphate and Ca/P ratio are not surrogates for PTH levels following total thyroidectomy. More research is needed to identify cost-effective strategies for postoperative calcium monitoring in patients undergoing total thyroidectomy. LEVEL OF EVIDENCE Retrospective cohort study.
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Affiliation(s)
- Catharine Kappauf
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brandon Gold
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Camilo Gonzalez-Velazquez
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
- Internal Medicine Department, Division of Endocrinology, Dr. Jose E. González, Universidad Autónoma de Nuevo León San Nicolás de los Garza, Mexico
| | - Monica H Xing
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Quinn F O'Malley
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Mykayla Sandler
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
| | - Raymond L Chai
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York, USA
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Betancourt C, Sanabria A. Post-thyroidectomy pain relief is enhanced by wound infiltration. A systematic review of randomized controlled trials. Surgeon 2024; 22:e133-e140. [PMID: 38360454 DOI: 10.1016/j.surge.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/01/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Thyroidectomy is a common surgical procedure. Traditional options for pain management, such as analgesics and nonsteroidal anti-inflammatory medications (NSAIDs), are limited by their side effects. Surgical wound infiltration with local anesthetics has the potential to reduce the need for analgesics in a number of surgical procedures. This systematic review and meta-analysis wanted to resolve these concerns and assess the efficacy of WI in the management of postoperative pain after thyroidectomy. MATERIAL AND METHODS The review adhered to Cochrane Collaboration and PRISMA standards. RCTs comparing WI with no infiltration or placebo were included. Patients with benign or malignant thyroid disease who underwent open thyroidectomy were eligible. Postoperative pain was assessed using a visual analogue scale (VAS) as the primary outcome. Time to first rescue dose, the need for analgesic rescue in the first 24 h, and total opioid analgesic consumption were secondary outcomes. Standardized mean difference (SMD) and odds ratio (OR) were used to analyze the data. RESULTS 16 randomized controlled trials involving 1202 patients were included. At 6 and 8 h postoperatively, WI exhibited a statistically significant impact on pain management. In the WI group, the need for analgesic rescue was significantly reduced. At 4 h postoperatively, non-anesthetic medications demonstrated a significant analgesic effect. CONCLUSIONS This systematic review and meta-analysis support the use of WI with local anesthetics for postoperative pain management after thyroidectomy. These findings have significant implications for improving perioperative care, especially in ambulatory settings where effective pain management is essential.
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Affiliation(s)
- Carlos Betancourt
- Head and Neck Service, Hospital Alma Mater. Medellín, Colombia. CEXCA, Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Alvaro Sanabria
- Head and Neck Service, Hospital Alma Mater. Medellín, Colombia. CEXCA, Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia; Department of Surgery, School of Medicine, Universidad de Antioquia, Cra. 51d #62-29, Medellin, Colombia.
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Conti KR, Ohlstein JF, Brown DM, Bedrosian JC, Yen DM. Incorporating Microdebrider Use in a Community-Based Thyroidectomy Practice. EAR, NOSE & THROAT JOURNAL 2024:1455613241251980. [PMID: 38708589 DOI: 10.1177/01455613241251980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Objectives: Substernal goiters often require surgery, yet their location presents challenges. Most can be removed via transcervical approach, but extent and relationship to mediastinal structures can merit consideration of sternotomy and assistance of colleagues. Despite widespread use in sinus surgery and previous literature reports, microdebrider use to facilitate transcervical removal of substernal goiters has not been broadly adopted. Our objective was to report our experience with use of the soft tissue shaver to facilitate substernal goiter deliver through a cervical incision in a community-based thyroidectomy practice. Methods: We reviewed thyroidectomy cases performed by a general otolaryngologist (D.M.Y.) in a community setting from January 2017 through December 2019. Four patients required microdebrider use for intracapsular debulking of substernal goiter to allow for transcervical removal. We discuss pre- and perioperative considerations, present computed tomography (CT) and operative images, review surgical technique, and report estimated blood loss (EBL), surgical time (T), complications, and length of stay. Results: Average EBL was 237.5 ml (range 100-500 ml). Average T was 137 minutes (range 121-170 minutes). No patients required sternotomy. One patient developed postoperative hematoma requiring evacuation and cautery of a bleeding site. No other complications were encountered, all patients were discharged after overnight observation. Conclusions: The microdebrider can be safely utilized by general otolaryngologists to facilitate transcervical removal of substernal goiters. Adoption of this familiar tool for a different surgical application can reduce the need for sternotomy, assistance of colleagues, or referral to a tertiary care center, with associated decrease in risk, morbidity, surgical time, length of stay, and cost, and improved patient convenience and satisfaction.
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Affiliation(s)
- Keith R Conti
- Division of Otolaryngology, Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Jason F Ohlstein
- Division of Otolaryngology, Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
- Specialty Physician Associates, Bethlehem, PA, USA
| | - David M Brown
- Division of Otolaryngology, Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
- Specialty Physician Associates, Bethlehem, PA, USA
| | - Jeffrey C Bedrosian
- Division of Otolaryngology, Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
- Specialty Physician Associates, Bethlehem, PA, USA
| | - David M Yen
- Division of Otolaryngology, Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
- Specialty Physician Associates, Bethlehem, PA, USA
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Brunet A, Rovira A, Quer M, Sanabria A, Guntinas-Lichius O, Zafereo M, Hartl DM, Coca-Pelaz A, Shaha AR, Marie JP, Vander Poorten V, Piazza C, Kowalski LP, Randolph GW, Shah JP, Rinaldo A, Simo R. Recurrent Laryngeal Nerve Intraoperative Neuromonitoring Indications in Non-Thyroid and Non-Parathyroid Surgery. J Clin Med 2024; 13:2221. [PMID: 38673494 PMCID: PMC11050584 DOI: 10.3390/jcm13082221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Introperative nerve monitoring (IONM) of the recurrent laryngeal nerve (RLN) is a well-established technique to aid in thyroid/parathyroid surgery. However, there is little evidence to support its use in non-thyroid or non-parathyroid surgery. The aim of this paper was to review the current evidence regarding the use of IONM in non-thyroid/non-parathyroid surgery in the head and neck and thorax. A literature search was performed from their inception up to January 2024, including the term "recurrent laryngeal nerve monitoring". IONM in non-thyroid/non-parathyroid surgery has mainly been previously described in oesophageal surgery and in tracheal resections. However, there is little published evidence on the role of IONM with other resections in the vicinity of the RLN. Current evidence is low-level for the use of RLN IONM in non-thyroid/non-parathyroid surgery. However, clinicians should consider its use in surgery for pathologies where the RLN is exposed and could be injured.
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Affiliation(s)
- Aina Brunet
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Universitari Bellvitge, Universitat de Barcelona, 08907 Barcelona, Spain
- Institut d’Investigació Biomèdica de Bellvitge, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Aleix Rovira
- Department of Otorhinolaryngology, Head and Neck Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK (R.S.)
| | - Miquel Quer
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia, Hospital Universitario San Vicente Fundación, CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellin 1226, Colombia
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Head and Neck Surgery, Jena University Hospital, 07747 Jena, Germany
| | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dana M. Hartl
- Thyroid Surgery Unit, Department of Otorhinolaryngology Head and Neck Surgery, Institute Gustave Roussy, 94805 Paris, France;
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain
| | - Ashok R. Shaha
- Department of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, Medical College, Cornell University, New York, NY 10065, USA
| | - Jean-Paul Marie
- Department of Otorhinolaryngology Head and Neck Surgery, Institute of Biomedical Research, University Hospital Rouen, 76000 Rouen, France;
| | - Vincent Vander Poorten
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Cesare Piazza
- Department of Otorhinolaryngology Head and Neck Surgery, ASST Spedali Civili of Brescha, School of Medicine, University of Brescia, 25123 Brescia, Italy
| | - Luiz P. Kowalski
- Department of Otorhinolaryngology Head and Neck Surgery, A.C. Camargo Cancer Center, Faculty of Medicine, University of Sao Paulo, São Paulo 03828-000, Brazil;
| | - Gregory W. Randolph
- Department of Otorhinolaryngology, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA
| | - Jatin P. Shah
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, Weil Medical College, Cornell University, New York, NY 10065, USA
| | | | - Ricard Simo
- Department of Otorhinolaryngology, Head and Neck Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK (R.S.)
- King’s College London, London SE5 8AF, UK
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Mardani P, Koulaian S, Fouladi D, Rajaie Ramsheh FS, Amirian A, Shahriarirad S, Malekhosseini SA, Shahriarirad R. Demographic, clinical, and surgical features of patients undergoing thyroidectomy due to thyroid lesions in Southern Iran: A cross-sectional study. Health Sci Rep 2024; 7:e2012. [PMID: 38567186 PMCID: PMC10985224 DOI: 10.1002/hsr2.2012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024] Open
Abstract
Background and Aims The incidence of thyroid cancer has witnessed a significant global increase and stands as one of the most prevalent cancers in Iran. This surge is primarily attributed to the escalating incidence of papillary thyroid cancer (PTC), with overdiagnosis emerging as an equally noteworthy factor. Consequently, this study aims to ascertain the incidence of thyroid cancer, along with its clinical presentation, demographic characteristics, and surgical features in patients undergoing thyroid surgery. Methods This cross-sectional study involved the evaluation of patient files from referral centers in Shiraz spanning the years 2015-2020. Demographic and clinical information pertaining to thyroid cancer was extracted and subsequently analyzed using SPSS software. Results A total of 533 documented cases of thyroid cancer undergoing surgery revealed an annual rate of 89 cases in our location. The average age of the patients was 43.9 ± 13.4 years (ranging from 13 to 92), with females constituting 429 (83.5%) of the cases, and 278 (54.1%) being malignant. Conventional PTC emerged as the most prevalent pathology, accounting for 239 (45.0%) of the cases. Patients with thyromegaly exhibited significantly higher incidences of nonmalignant tumors (p = 0.01), while those with malignant tumors were notably younger than those with nonmalignant tumors (p = 0.001). Conclusion Our study revealed a progressive rise in the number of patients undergoing thyroidectomy over the years, with PTC constituting the majority of cases. Malignant cases were more frequently observed in younger patients, and in smaller lesion sizes, highlighting the importance of early screening and optimizing detection methods, especially in high-risk populations.
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Affiliation(s)
- Parviz Mardani
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- Shiraz Transplant Research CenterShiraz University of Medical SciencesShirazIran
| | - Sepehr Koulaian
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Damoun Fouladi
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | | | - Armin Amirian
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
| | | | | | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
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Cohen O, Amiad ND, Shavit E, Hod K, Khafif A. Drainless thyroid surgeries including goiter or central neck dissection: a case-control study. Eur Arch Otorhinolaryngol 2024; 281:1435-1441. [PMID: 38057490 DOI: 10.1007/s00405-023-08343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/06/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Despite ample of evidence regarding feasibility of simple drainless thyroid surgeries, the evidence of feasibility of such procedures in goiters and central neck dissections remains limited. METHODS Patients undergoing total thyroidectomy (TT) between January 2017 and July 2022 were included. The study included two study groups: drainless TT with central neck dissection (CND) and drainless TT due to goiter, which were compared to two controls: non-goiter drainless TT and drained TT for goiter or with CND. Main outcome was post-operative seroma rate. RESULTS 156 patients met the inclusion criteria for each of the group. No significant differences between groups were found for permanent hypocalcemia, and other complications. Post-operative seroma was found in nine patients (5.8%), all from study groups. No significant differences between groups were found for local infections, aspirations, post-discharge drain insertion. CONCLUSIONS Complex drainless thyroid surgeries, including goiter and CND, are feasible and do not seem to significantly increase rate of post-operative seromas or infections.
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Affiliation(s)
- Oded Cohen
- ARM-Center for Otolaryngology-Head and Neck Surgery Center and Oncology, Assuta Medical Center, 20 Habarzel Street, Tel Aviv, Israel.
- Ben Gurion University of the Negev, Beer Sheva, Israel.
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel.
| | - Noa Dagul Amiad
- ARM-Center for Otolaryngology-Head and Neck Surgery Center and Oncology, Assuta Medical Center, 20 Habarzel Street, Tel Aviv, Israel
| | - Eitan Shavit
- ARM-Center for Otolaryngology-Head and Neck Surgery Center and Oncology, Assuta Medical Center, 20 Habarzel Street, Tel Aviv, Israel
| | - Keren Hod
- Ben Gurion University of the Negev, Beer Sheva, Israel
- Department of Academy and Research, Assuta Medical Centers, Tel Aviv, Israel
| | - Avi Khafif
- ARM-Center for Otolaryngology-Head and Neck Surgery Center and Oncology, Assuta Medical Center, 20 Habarzel Street, Tel Aviv, Israel
- Ben Gurion University of the Negev, Beer Sheva, Israel
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Devgan Y, Mayilvaganan S, Mishra A, Chand G, Agarwal G, Agarwal A. Comparison of indocyanine green angiography vs intraoperative parathyroid hormone in early prediction of risk of post-thyroidectomy hypocalcemia: a prospective cohort study. Ann Med Surg (Lond) 2024; 86:678-688. [PMID: 38333253 PMCID: PMC10849419 DOI: 10.1097/ms9.0000000000001578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/22/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction Indocyanine green (ICG) angiography is the 'real-time intraoperative imaging' technique used to reduce the chances of hypoparathyroidism in post-thyroidectomy patients. In our study, the authors predicted the risk of early post-thyroidectomy hypocalcemia by intraoperative evaluation of parathyroid gland perfusion by ICG angiography. Materials and methods In patients who underwent total thyroidectomy, ICG angiography was done using the SPY PHI imaging system (Stryker). Post-thyroid specimen removal, scoring of parathyroids was done in spy contrast mode. All 4 or <4 visualized parathyroids were scored for vascularity with the highest score of 8. Serum ionized calcium was done 6 h postsurgery and on the morning and evening of postoperative days 1 and 2. Calcium supplements were given to only those who developed clinical or severe biochemical hypocalcemia. Results Out of 60, postoperative hypocalcemia was noted in 41 patients. Total ICG score ≤5 was seen in 34 patients, out of which 28 developed postoperative hypocalcemia showing PPV 82.3% and diagnostic accuracy of 68.3% while iPTH (4.28 pmol/l) showed PPV 76.7 and diagnostic accuracy 70 %. In eight patients, none of the glands was scored as 2 (White) and all these patients developed hypocalcemia requiring calcium infusion. Conclusion The absence of visualization of at least 1 well-perfused (score 2) gland on ICG angiography is highly predictive of hypocalcemia and the majority of patients with total ICG score ≤5 developed hypocalcemia in the immediate postoperative period. ICG is a good predictor of the absence of hypoparathyroidism after thyroidectomy and is comparable to iPTH in the prediction of post-thyroidectomy hypocalcemia.
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Affiliation(s)
| | - Sabaretnam Mayilvaganan
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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11
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van Dijk SPJ, van Driel MHE, van Kinschot CMJ, Engel MFM, Franssen GJH, van Noord C, Visser WE, Verhoef C, Peeters RP, van Ginhoven TM. Management of Postthyroidectomy Hypoparathyroidism and Its Effect on Hypocalcemia-Related Complications: A Meta-Analysis. Otolaryngol Head Neck Surg 2024; 170:359-372. [PMID: 38013484 DOI: 10.1002/ohn.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/12/2023] [Accepted: 11/04/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE The aim of this Meta-analysis is to evaluate the impact of different treatment strategies for early postoperative hypoparathyroidism on hypocalcemia-related complications and long-term hypoparathyroidism. DATA SOURCES Embase.com, MEDLINE, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and the top 100 references of Google Scholar were searched to September 20, 2022. REVIEW METHODS Articles reporting on adult patients who underwent total thyroidectomy which specified a treatment strategy for postthyroidectomy hypoparathyroidism were included. Random effect models were applied to obtain pooled proportions and 95% confidence intervals. Primary outcome was the occurrence of major hypocalcemia-related complications. Secondary outcome was long-term hypoparathyroidism. RESULTS Sixty-six studies comprising 67 treatment protocols and 51,096 patients were included in this Meta-analysis. In 8 protocols (3806 patients), routine calcium and/or active vitamin D medication was given to all patients directly after thyroidectomy. In 49 protocols (44,012 patients), calcium and/or active vitamin D medication was only given to patients with biochemically proven postthyroidectomy hypoparathyroidism. In 10 protocols (3278 patients), calcium and/or active vitamin D supplementation was only initiated in case of clinical symptoms of hypocalcemia. No patient had a major complication due to postoperative hypocalcemia. The pooled proportion of long-term hypoparathyroidism was 2.4% (95% confidence interval, 1.9-3.0). There was no significant difference in the incidence of long-term hypoparathyroidism between the 3 supplementation groups. CONCLUSIONS All treatment strategies for postoperative hypocalcemia prevent major complications of hypocalcemia. The early postoperative treatment protocol for postthyroidectomy hypoparathyroidism does not seem to influence recovery of parathyroid function in the long term.
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Affiliation(s)
- Sam P J van Dijk
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M H Elise van Driel
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Caroline M J van Kinschot
- Department of Internal Medicine, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands
- Department of Internal Medicine and Thyroid Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maarten F M Engel
- Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gaston J H Franssen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Charlotte van Noord
- Department of Internal Medicine, Maasstad Hospital Rotterdam, Rotterdam, The Netherlands
| | - W Edward Visser
- Department of Internal Medicine and Thyroid Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine and Thyroid Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tessa M van Ginhoven
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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12
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Finn CB, Sharpe JE, Krumeich LN, Ginzberg SP, Soegaard Ballester JM, Tong JK, Wachtel H, Fraker DL, Kelz RR. The use and costs of same-day surgery versus overnight admission for total thyroidectomy: A multi-state, all-payer analysis. Surgery 2024; 175:207-214. [PMID: 37989635 PMCID: PMC10870294 DOI: 10.1016/j.surg.2023.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/29/2023] [Accepted: 06/09/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Outpatient thyroidectomy is increasingly favored, given evidence of safety and convenience for selected patients. However, the prevalence of same-day discharge is unclear. We aimed to evaluate temporal trends, hospital characteristics, and costs associated with same-day discharge after total thyroidectomy in an all-payer, multi-state cohort. METHODS We included patients aged ≥18 years who underwent a total thyroidectomy (2013-2019) using Healthcare Cost and Utilization Project data. Admission type was defined as same-day, overnight, or inpatient based on length of stay. Same-day patients were propensity-score matched 1:1 with overnight patients. Hospital characteristics and costs were compared in the matched cohort. RESULTS Among 86,187 patients who underwent total thyroidectomy, 16,743 (19.4%) cases were same-day, 59,778 (69.4%) were overnight, and 9,666 (11.2%) were inpatient. The proportion of patients who underwent same-day thyroidectomy increased from 14.8% to 20.8% over the study period (P < .001), whereas overnight admissions decreased from 72.9% to 68.8% (P < .001). In total, 9,571 same-day patients were matched to 9,571 overnight patients. Same-day patients had higher odds of treatment at a certified cancer center (odds ratio 1.77; 95% confidence interval 1.65-1.90), Accreditation Council for Graduate Medical Education-accredited teaching hospital (odds ratio 1.72; 95% confidence interval 1.61-1.85), and high-volume hospital (odds ratio 1.53; 95% confidence interval 1.42-1.65). Pairwise cost differences showed median savings of $974 (interquartile range -1,610 to 3,491) for same-day relative to overnight admission (P < .001). CONCLUSION Although over two-thirds of patients are admitted overnight, same-day total thyroidectomy is increasingly performed. Same-day thyroidectomy may be a lower-cost option for selected patients, particularly in specialty centers with experience in thyroidectomy.
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Affiliation(s)
- Caitlin B Finn
- Department of Surgery, Weill Cornell Medicine, New York, NY; Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA; Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
| | - James E Sharpe
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Lauren N Krumeich
- Massachusetts General Hospital, Department of Surgery, Boston, MA; Brigham and Women's Hospital, Department of Surgery, Boston, MA. https://twitter.com/LaurenNorell
| | - Sara P Ginzberg
- Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA. https://twitter.com/SaraGinzbergMD
| | - Jacqueline M Soegaard Ballester
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA. https://twitter.com/JMSoegaard
| | - Jason K Tong
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA. https://twitter.com/JasonTong_MD
| | - Heather Wachtel
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Douglas L Fraker
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Rachel R Kelz
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA; Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA. https://twitter.com/surgeryspice
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13
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Xie R, Wallace LA, Lindeman BM, Porterfield JR, Chu DI, Chen H, Wang TN. Physician-Targeted Interventions Reduce Surgical Expense and Improve Value-Driven Health Outcomes. J Surg Res 2023; 292:79-90. [PMID: 37597453 DOI: 10.1016/j.jss.2023.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 06/30/2023] [Accepted: 07/12/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Increasing health-care costs in the United States have not translated to superior outcomes in comparison to other developed countries. The implementation of physician-targeted interventions to reduce costs may improve value-driven health outcomes. This study aimed to evaluate the effectiveness of physician-targeted interventions to reduce surgical expenses and improve care for patients undergoing total thyroidectomies. METHODS Two separate face-to-face interventions with individual surgeons focusing on surgical expenses associated with thyroidectomy were implemented in two surgical services (endocrine surgery and otolaryngology) by the surgical chair of each service in Jun 2016. The preintervention period was from Dec 2014 to Jun 2016 (19 mo, 352 operations). The postintervention period was from July 2016 to January 2018 (19 mo, 360 operations). Descriptive statistics were utilized, and differences-in-differences were conducted to compare the pre and postintervention outcomes including cost metrics (total costs, fixed costs, and variable costs per thyroidectomy) and clinical outcomes (30-d readmission rate, days to readmission, and total length of stay). RESULTS Patient demographics and characteristics were comparable across pre- and post-intervention periods. Post-intervention, both costs and clinical outcomes demonstrated improvement or stability. Compared to otolaryngology, endocrine surgery achieved additional savings per surgery post-intervention: mean total costs by $607.84 (SD: 9.76; P < 0.0001), mean fixed costs by $220.21 (SD: 5.64; P < 0.0001), and mean variable costs by $387.82 (SD: 4.75; P < 0.0001). CONCLUSIONS Physician-targeted interventions can be an effective tool for reducing cost and improving health outcomes. The effectiveness of interventions may differ based on specialty training. Future implementations should standardize these interventions for a critical evaluation of their impact on hospital costs and patient outcomes.
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Affiliation(s)
- Rongbing Xie
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Lauren A Wallace
- Department of Public Health Sciences, University of North Carolina Charlotte, Charlotte, North Carolina
| | - Brenessa M Lindeman
- Division of Breast and Endocrine Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - John R Porterfield
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Daniel I Chu
- Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Herbert Chen
- Division of Breast and Endocrine Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Thomas N Wang
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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14
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Hassan CH, Deberge S, Jegoux F. Outpatient parotidectomy: Outcomes, safety and satisfaction. Am J Otolaryngol 2023; 44:103974. [PMID: 37437335 DOI: 10.1016/j.amjoto.2023.103974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE Parotidectomies are rarely performed on an outpatient basis. The specific perioperative outcomes and their management remains insufficiently described to change daily practice. The objectives were to study the outcomes, the complications and the patient satisfaction rate in parotidectomy performed on an outpatient basis. MATERIALS AND METHODS We conducted a retrospective monocentric database study on 85 patients who underwent parotidectomy as a first and sole procedure from 2015 to 2020. We analyzed perioperative outcomes between outpatients and inpatients. RESULTS Among 28 outpatients and 57 inpatients, no significant differences in total perioperative complications (p = .66; OR = 1.25; 95 % confidence interval (CI) [0.47; 3.36]), reoperations (p = .55), readmissions (p = 1), or unplanned visits (p = .52) were shown in multivariate analysis. The conversion rate for surgical reasons was 8.6 %, and the satisfaction rate was high. CONCLUSION Although outpatient parotidectomies should be as safe as for inpatients, the high rate of minor complications requires specific perioperative management, such as a systematic early postoperative visit and optimized preoperative information in order to be carried out with minimal issues.
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Affiliation(s)
| | - Sarah Deberge
- ENT Surgery, CHU Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes, France
| | - Franck Jegoux
- ENT Surgery, CHU Pontchaillou, 2 rue Henri Le Guilloux, 35033 Rennes, France
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15
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Mughal A, Vardag ABS, Deewani MH, Wasif M, Mughal M, Awan S, Unar A. Unilateral Thyroid Lobectomy as Day Care Procedure: A Cross Sectional Study with Literature Review on the Safety and Cost Effectiveness. Int Arch Otorhinolaryngol 2023; 27:e625-e629. [PMID: 39139710 PMCID: PMC11321666 DOI: 10.1055/s-0042-1758714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 09/12/2022] [Indexed: 08/15/2024] Open
Abstract
Introduction Thyroid nodules are common globally in almost one fifth of the adult population. The gold standard treatment for thyroid nodule is thyroid lobectomy or total thyroidectomy depending upon the diagnosis. Thyroidectomy has a few known complications but, as per the ATA consensus statement, it is a safe surgery to be done as a day care procedure. Objective To access the feasibility and safety of thyroid lobectomy as a day care surgery and its effect on decreasing overall financial burdens. Methods This retrospective chart review was done from 2006 to 2022. A total of 736 patients underwent thyroid lobectomy among which only 56 were done as day care surgery. Data analysis was done using the IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY, USA). Results A total of 40% of the population was male. The mean age of the study population was 42 years. Bethesda II was the most encountered diagnosis, with a rate of 69%. The majority of patients were discharged after 6 hours of postoperative observation. The only complication encountered was seroma, which was seen in two patients. Conclusion Thyroid lobectomy appears to be a safe procedure with a drastic difference in overall cost as a day care procedure. We recommend switching the practice of inpatient thyroid lobectomy to a day care procedure in carefully selected candidates. The major hurdle in day care lobectomy can be approval from insurance.
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Affiliation(s)
| | | | | | | | - Marhaba Mughal
- Address for correspondence Marhaba Mughal, MBBS Department of Otolaryngology, The Aga Khan UniversityNational Stadium Road, Karachi Sindh 74800Pakistan
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16
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Ezzy M, Alameer E. Predictors and Preventive Strategies of Bleeding After Thyroid Surgery. Cureus 2023; 15:e47575. [PMID: 38021981 PMCID: PMC10666654 DOI: 10.7759/cureus.47575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Postoperative compressive neck hematoma occurs in approximately 0.1% to 1.7% of cases, most occurring within the first six hours after surgery. Thyroid pathology, patient predisposition, and surgical technique are major risk factors for postoperative hematoma. This narrative review describes current perspectives on predicting and preventing bleeding following thyroid surgery. Predictors of bleeding after thyroid surgery include patient-related factors such as male sex and age, surgery-related factors like total thyroidectomy and operations for thyroid malignancy, and surgeon-related factors. Hemostasis is the primary focus after preserving critical structures in thyroid surgery. The clamp-and-tie technique has been the standard method for dividing the thyroid gland's main vascular pedicles for many years. Bipolar electrocautery has been used for vessels of small size. However, advanced bipolar and ultrasound energy and hybrid devices are now available options that may reduce operative time without increasing costs or complications. In cases where small bleeders close to critical structures are present and the clamp-and-tie technique is not feasible, hemostatic agents are commonly used. Drains do not appear to provide any significant benefits in preventing the sequelae of bleeding after thyroid surgery.
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Affiliation(s)
- Mohsen Ezzy
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Ehab Alameer
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
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17
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Liu AQ, Butskiy O, Cheung VWF, Anderson DW. The timing of drain removal in parotidectomies: outcomes of removal at 4 h post-operatively and a Canadian survey of practice patterns. J Otolaryngol Head Neck Surg 2023; 52:60. [PMID: 37705038 PMCID: PMC10500887 DOI: 10.1186/s40463-023-00665-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 08/28/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND The post-operative management of parotidectomies is highly provider dependent. No guidelines are currently available for timing of parotid drain removal. This study aimed to assess: (1) outcomes and complications after early drain removal (< 4 h, post-operative day [POD] 0) versus late drain removal (POD ≥ 1); (2) current Canadian provider practices. METHODS A single surgeons ten-year parotidectomy practice was reviewed, spanning his practice change from routine POD ≥ 1 drain removal to POD 0 removal, with extraction of patient demographic, disease, and complication variables. An anonymous, cross-sectional survey on parotid drain practices was distributed to Canadian Society of Otolaryngology-Head and Neck Surgery members. Descriptive statistics, Wilcoxon Rank Sum, and unpaired student's t-tests were calculated. RESULTS In total, 526 patients were included and 44.7% (235/526) had drains removed POD 0. There was no significant difference in hematoma or seroma rates between the POD 0 and POD ≥ 1 drain removal cohorts. The national survey on parotid drain management had 176 responses. The majority (67.9%) reported routinely using drains after parotidectomy and 62.8% reported using a drain output based criteria for removal. The most common cut-off output was 30 ml in 24 h (range 5-70 ml). CONCLUSION There was no difference in hematoma or seroma rates for patients with parotid drains removed on POD 0 versus POD ≥ 1. Our national survey found significant variation in Canadian parotidectomy drain removal practices, which may be an area that can be further assessed to minimize hospital resources and improve patient care.
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Affiliation(s)
- Alice Q Liu
- Division of Otolaryngology-Head and Neck Surgery, Diamond Health Care Centre, University of British Columbia, 2775 Laurel St, 4th Floor ENT Clinic, Vancouver, BC, V5Z 1M9, Canada.
| | - Oleksandr Butskiy
- Division of Otolaryngology-Head and Neck Surgery, Diamond Health Care Centre, University of British Columbia, 2775 Laurel St, 4th Floor ENT Clinic, Vancouver, BC, V5Z 1M9, Canada
| | | | - Donald W Anderson
- Division of Otolaryngology-Head and Neck Surgery, Diamond Health Care Centre, University of British Columbia, 2775 Laurel St, 4th Floor ENT Clinic, Vancouver, BC, V5Z 1M9, Canada
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Thakkar K, Nwangene NL, Maharjan R, Francis S, Carredo CKC, Dahal R, Khan A. A Comprehensive Management of Neck Hematoma in Post-Thyroidectomy Patient for Papillary Thyroid Cancer: A Case Report. Cureus 2023; 15:e42689. [PMID: 37649935 PMCID: PMC10464918 DOI: 10.7759/cureus.42689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
A post-thyroidectomy hematoma is a rare, potentially fatal surgical complication that may present as hoarseness, dysphagia, and difficulty in breathing, which could progress to complete airway obstruction and, ultimately, death. The treatment for a neck hematoma is emergent surgical drainage. While certain precautions can be taken to prevent this complication, such as the cessation of any anticoagulants prior to surgery, it is still a feared complication of thyroidectomy with an increasing prevalence. In this paper, we discuss a case of a 62-year-old female with papillary thyroid cancer who presents with a postoperative complication of a neck hematoma requiring emergent surgery and conduct a literature review on managing post-thyroidectomy hematomas.
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Affiliation(s)
- Keval Thakkar
- Department of Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, USA
- Department of Internal Medicine, Larkin Community Hospital, South Miami, USA
| | | | - Reeju Maharjan
- Department of Neurology, V.N. Karazin Kharkiv National University, Kharkiv, UKR
| | - Sandra Francis
- Department of Medicine, Windsor University School of Medicine, Cayon, KNA
| | | | - Rojaj Dahal
- Department of Internal Medicine, Manipal College of Medical Sciences, Pokhara, NPL
| | - Aadil Khan
- Department of Cardiology, University of Illinois Chicago, Chicago, USA
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Christou N, Di Maria S, Mirallié E, Noullet S, Mathonnet M, Menegaux F. Ambulatory thyroidectomy. Recommendations of the Association francophone de chirurgie endocrinienne (AFCE), with the Société française d'endocrinologie (SFE) and the Société française de médecine nucléaire (SFMN). J Visc Surg 2023:S1878-7886(23)00072-3. [PMID: 37211444 DOI: 10.1016/j.jviscsurg.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Before ambulatory thyroidectomy is proposed, the patient and his family and/or friends will need to be informed by the surgeon of the specificity of this procedure, the normal postoperative effects of a thyroidectomy, and potential complications. Also known as outpatient thyroid surgery, it can only be proposed by an experienced surgeon supported by an adequately trained medical and paramedical team. The healthcare establishment must be in possession of all the resources needed in ambulatory management, with continuity of care guaranteed 24h/24 7d/7 in the event of possible emergency rehospitalization. In all cases, contact the day after the operation between the healthcare facility and the patient is imperative. Ambulatory management can be proposed for lobo-isthmectomy or isthmectomy, possibly involving lymph node dissection. It is also possible for secondary totalization of thyroidectomy (following lobectomy). On the other hand, indications for single-stage total thyroidectomy must be limited and ensure proximity between the patient's home and a healthcare structure with a platform adapted to the pathology necessitating surgical intervention (non-plunging euthyroid goiter). A precise clinical pathway must be set out, including pre-, peri- and postoperative protocols having been formalized for surgery (hemostasis procedures) and for anesthesia (prevention of pain, of vomiting and of hypertension). We recommend at least 6hours of postoperative surveillance in outpatient care. When outpatient treatment is not possible or not recommended, hospitalization stay after thyroidectomy can be limited to 24hours, except in the event of postoperative complications, or a need for effectively dosed anticoagulant treatment.
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Affiliation(s)
- Niki Christou
- Digestive, Endocrine and General Surgery Department, University Hospital Center of Limoges, Limoges, France.
| | - Sophie Di Maria
- Department of Anesthesia-Resuscitation, University Hospital Center of Pitié-Salpêtrière, AP-HP, Sorbonne University, Paris, France
| | - Eric Mirallié
- Cancer, Digestive and Endocrine Surgery Department, Institut des Maladies de l'Appareil Digestif, University Hospital Center of Nantes, Nantes, France
| | - Séverine Noullet
- Department of General, Visceral and Endocrine Surgery, University Hospital Center of Pitié-Salpêtrière, AP-HP, Sorbonne University, Paris, France
| | - Muriel Mathonnet
- Digestive, Endocrine and General Surgery Department, University Hospital Center of Limoges, Limoges, France
| | - Fabrice Menegaux
- Department of General, Visceral and Endocrine Surgery, University Hospital Center of Pitié-Salpêtrière, AP-HP, Sorbonne University, Paris, France
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20
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Su D, Zhang Z, Xia F, Li X. The safety, benefits and future development of overnight and outpatient thyroidectomy. Front Endocrinol (Lausanne) 2023; 14:1110038. [PMID: 37091845 PMCID: PMC10113618 DOI: 10.3389/fendo.2023.1110038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/10/2023] [Indexed: 04/08/2023] Open
Abstract
With the development of medical care, the safety of thyroidectomy is improving year by year. Due to economic benefits and other advantages of the overnight and outpatient thyroidectomy, more and more patients and medical institutions have favored overnight and outpatient thyroidectomy, and its proportion in thyroidectomy has increased year by year. However, overnight and outpatient thyroidectomy still faces many challenges and remains to be improved. In this review, we focused on the recent progress and the relevant clinical features of overnight and outpatient thyroidectomy, including its safety, economic benefits, etc., which may bring valuable clues and information for further improvements of patient benefits and promotions of overnight or outpatient thyroidectomy in the future.
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Affiliation(s)
- Duntao Su
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zeyu Zhang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fada Xia
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Xinying Li, ; Fada Xia,
| | - Xinying Li
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Xinying Li, ; Fada Xia,
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Tripyla N, Katsas K, Karagkouni K, Liosis I, Ntelis S, Linos D. Evaluation of the effect of Mozart music on pain and respiratory rate after thyroidectomy. Hormones (Athens) 2023; 22:113-119. [PMID: 36418659 DOI: 10.1007/s42000-022-00421-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 11/08/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Pain has always been a major concern in postoperative care. The aim of this study was to assess the impact of Mozart music on postoperative pain and physiological parameters in patients who underwent total thyroidectomy. METHODS Patients scheduled for total thyroidectomy were randomly assigned to a music group or a control group. The music intervention was applied immediately after surgery, whereas the control group received only usual care. Measurements of pain perception and physiological parameters were performed before, during, and after the music intervention in the music group and at the same time points in the control group. Pain was evaluated with the visual analog scale. RESULTS In a study population of 50 patients, a higher rate of decrease in pain was observed in the music group after the first 10 min of the music intervention compared to the control group (estimate = - 1.329; 95% CI [- 2.490, - 0.169]). Music also reduced respiratory rate by 1.31 rates/min more in the music group than in the control group at every assessment point (95% CI [- 2.171, - 0.451]). Changes in the remaining physiological parameters were not statistically significant between the music and the control group and within each group. CONCLUSION This study suggests that the use of music during immediate postoperative care after thyroidectomy could accelerate pain relief and lead to a greater decline of respiratory rate compared to that achieved in usual care. TRIAL REGISTRATION NUMBER NCT04699084, 30/12/2020.
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Affiliation(s)
- Niki Tripyla
- Department of Surgery, Evgenidion Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Konstantinos Katsas
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis Marousi, Greece
| | - Katerina Karagkouni
- Department of Surgery, Evgenidion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Liosis
- Department of Surgery, Evgenidion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Ntelis
- Institute of Preventive Medicine, Environmental and Occupational Health, Prolepsis Marousi, Greece
| | - Dimitrios Linos
- Department of Surgery, Evgenidion Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Surgical Department of Hygeia Hospital, Erithrou Stavrou 4, 15 123, Marousi, Greece
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Yadav D, Sharma PK, Malviya R, Mishra PS. Strategies for Treatment of Thyroid Cancer. Curr Drug Targets 2023; 24:406-415. [PMID: 36815636 DOI: 10.2174/1389450124666230222093308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/03/2022] [Accepted: 12/19/2022] [Indexed: 02/24/2023]
Abstract
More people are diagnosed with thyroid cancer than any other endocrine tumor. Differentiated thyroid cancer is often treated by removing the thyroid gland (thyroidectomy), iodizing radiation, or inhibiting thyroid stimulating hormone (TSH). Advanced thyroid carcinomas are notoriously resistant to chemotherapy, thus the pursuit of alternative treatments is vital. The best methods for treating individuals with advanced nonmedullary and medullary thyroid carcinomas are discussed in this post. Numerous tyrosine kinase inhibitors and antiangiogenic inhibitors, two types of novel target therapy, have shown promise in studies for individuals with thyroid cancer. Both the positive and unfavourable outcomes of clinical studies of these drugs were addressed. The findings presented here are encouraging, but more study is required to establish whether or not this method is effective in the treatment of thyroid cancer.
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Affiliation(s)
- Deepika Yadav
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Pramod Kumar Sharma
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Rishabha Malviya
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Prem Shankar Mishra
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
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Hsu S, Melucci AD, Dave YA, Chennell T, Fazendin J, Suh I, Moalem J. Outpatient endocrine surgery practice patterns are highly variable among US endocrine surgery fellowship programs. Surgery 2023; 173:76-83. [PMID: 36192212 DOI: 10.1016/j.surg.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/19/2022] [Accepted: 05/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Current studies and guidelines have reported that outpatient endocrine surgery is safe. However, none recommend specific postoperative protocols. METHODS An internet-based survey, developed using expert input, was distributed to current (2021-2022) endocrine surgery fellows in American Association of Endocrine Surgeons-accredited programs (n = 23). Programs with ≤2% same-day discharge rate were compared with those with ≥2% same-day discharge rate. RESULTS The survey response rate was 91% (21/23), representing 20 United States institutions performing >15,000 cervical endocrine operations annually. The same-day discharge rate after total thyroidectomy was not normally distributed across institutions (P < .0001) but appeared bimodal, highlighting dogmatic differences in the pursuit of same-day discharge. Nine programs had ≤2% same-day discharge rate, whereas seven had ≥90% same-day discharge rate. Fourteen (70%) reported minimum observation periods before discharge, without consistency across procedures or institutions. Total thyroidectomy patients were observed longer. Fourteen (70%) reported no geographic restrictions for same-day discharge. In programs with >2% same-day discharge (n = 11), clinical and operative factors inconsistently influenced same-day discharge after thyroidectomy. Living alone precluded same-day discharge in 3 programs. Lateral neck dissection and chronic anticoagulation each greatly reduced same-day discharge in one program and precluded same-day discharge in another. Central neck dissection, Graves' disease, substernal goiter, continuous positive airway pressure use, difficult/bloody operation, and signal on nerve stimulation had no or minimal effect on same-day discharge. Postoperative medication recommendations varied among programs. Although anticoagulation/antiplatelet agents were similarly held preoperatively across programs, resumption varied. Narcotics were routinely prescribed in 35%. CONCLUSION Same-day discharge is not uniform across endocrine surgery training programs and is likely primarily driven by surgeon preference. Factors influencing same-day discharge vary significantly among programs.
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Affiliation(s)
- Shawn Hsu
- Department of Surgery, University of Rochester Medical Center, Rochester, NY.
| | - Alexa D Melucci
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Yatee A Dave
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Todd Chennell
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Jessica Fazendin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Insoo Suh
- Department of Surgery, NYU Langone Health, New York, NY
| | - Jacob Moalem
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
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Sun H, Chu Y, Zhang G, Zheng G, Zheng H. The ambulatory transoral endoscopic thyroidectomy vestibular approach is safe and economical for patients with thyroid nodules. Front Endocrinol (Lausanne) 2023; 14:1116280. [PMID: 36843594 PMCID: PMC9950724 DOI: 10.3389/fendo.2023.1116280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Ambulatory thyroid surgery has been increasingly performed in recent years. However, the feasibility of the ambulatory transoral endoscopic thyroidectomy vestibular approach (TOETVA) has not been evaluated. We aimed to evaluate the safety, economy, and mental health outcomes of ambulatory TOETVA. METHODS We retrospectively reviewed the data of patients who underwent TOETVA between March 2019 and August 2022. The procedure was performed by a skilled surgical team from the Department of Thyroid Surgery of the affiliated Yantai Yuhuangding Hospital of Qingdao University. Patients were enrolled in the ambulatory (n=166) and conventional (n=290) groups, based on their chosen procedure. We analyzed patients' clinical characteristics, surgical outcomes, Hamilton Anxiety Rating Scale (HAM-A) scores, and hospitalization costs. RESULTS Of 456 patients, 166 underwent ambulatory TOETVA and 290 underwent conventional TOETVA. No significant differences were found in clinical and surgical characteristics between the groups, including sex (P=0.363), age (P=0.077), body mass index (P=0.351), presence of internal diseases (P=0.613), presence of Hashimoto's thyroiditis (P=0.429), pathology (P=0.362), maximum tumor diameter (P=0.520), scope of surgery (P=0.850), or operative time (P=0.351). There were no significant differences in maximum tumor diameter (P=0.349), extrathyroidal tissue invasion (P=0.516), number of retrieved central lymph nodes (P=0.069), or metastatic central lymph nodes (P=0.897) between the groups. No significant differences were found in complications, including transient hypoparathyroidism (P=0.438), transient vocal cord palsy (P=0.876), transient mental nerve injury (P=0.749), permanent mental nerve injury (P=0.926), and other complications (P=1.000). Ambulatory patients had shorter hospital stays (P<0.001) and reduced hospitalization costs (P<0.001). There was no significant difference in HAM-A scores between the groups (P=0.056). CONCLUSIONS Ambulatory TOETVA is a safe, feasible, and cost-effective procedure for selected patients. This procedure resulted in shorter hospital stays, decreased medical costs, and did not increase patient anxiety. To ensure patient safety, surgical teams must inform patients of the indications, when to seek help, and how to receive the fastest medical attention.
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Affiliation(s)
- Haiqing Sun
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Yongli Chu
- Office of Academic Research, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Guojun Zhang
- Department of Thyroid and Breast Surgery, Changle People’s Hospital Affiliated to Weifang Medical College, Weifang, Shandong, China
| | - Guibin Zheng
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Haitao Zheng
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
- *Correspondence: Haitao Zheng,
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Eltelety AM, Terris DJ. Minimally invasive thyroid and parathyroid surgery: modifications for low-resource environments. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [DOI: 10.1186/s43163-022-00341-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
AbstractMinimally invasive thyroidectomy (MIT) and parathyroidectomy (MIP) are gaining popularity in the current surgical practice. The need for specific equipment and technology is an obstacle in the low-resource environment. This article provides simple and practical guidance for surgeons practicing in low-resource environments to help them attain quality surgical practice, maintain patient safety, preserve available resources, and achieve the best outcomes.
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PAVLIDIS ET, MICCOLI P. Hemostasis during thyroidectomy in the era of energy-based devices: an update. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.22.05398-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Feasibility and Safety of Ambulatory Transoral Endoscopic Thyroidectomy via Vestibular Approach (TOETVA). World J Surg 2022; 46:2678-2686. [PMID: 35854011 PMCID: PMC9295883 DOI: 10.1007/s00268-022-06666-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 11/08/2022]
Abstract
Background In search of an ideal cosmesis, transoral endoscopic thyroidectomy via vestibular approach (TOETVA) has recently been introduced to avoid a visible scar. Although ambulatory thyroid surgery is considered safe in carefully selected patients, this remains unclear for TOETVA. Methods All consecutive adult patients who underwent ambulatory TOETVA or open thyroid surgery at a French university hospital were prospectively enrolled from 12/2020 until 11/2021. The primary outcome was postoperative morbidity (recurrent laryngeal nerve (RLN) palsy, re-intervention for bleeding, wound morbidity, or hospital readmission). The secondary outcome was quality of life (QoL), measured by a survey including a validated questionnaire (SF-12) and a modified thyroid surgery questionnaire six weeks after surgery. Results Throughout the study period, 374 patients underwent a unilateral lobectomy or isthmectomy in ambulatory setting, of which 34 (9%) as TOETVA (including 21 (62%) for a possible malignancy). In the TOETVA group, younger age (median 40 (IQR 35–50) vs. 51 (40–60) years, P < 0.001) and lower BMI (median 23.1 (20.9–25.4) vs. 24.9 (22.1–28.9) kg/m2, P = 0.001) were noted. No cases were converted to open cervicotomy. TOETVA was at least as good as open cervicotomy with nil versus four (1%) re-interventions for bleeding, one temporary (5%) versus 13 (4%) (temporary) RLN palsies, and one (<1%) wound infection (open cervicotomy group). No hospital readmissions occurred in all ambulatory surgery patients. No differences were found in physical (P = 0.280) and mental (P = 0.569) QoL between TOETVA and open surgery. Conclusions In carefully selected patients, the feasibility and safety of ambulatory TOETVA are comparable to open surgery. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06666-y.
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Histopathological Characteristics of N1b Papillary Thyroid Carcinoma are Associated with Risk of Recurrence. World J Surg 2022; 46:1917-1925. [PMID: 35543736 DOI: 10.1007/s00268-022-06581-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The presence of cervical lymph node (LN) metastasis at the initial presentation of papillary thyroid carcinoma (PTC) constitutes an independent risk factor for disease recurrence, increases the risk for mortality, and impacts overall outcome. The 2016 American Joint Committee on Cancer raised the age cutoff for PTC staging from 45 to 55 years for better prediction of overall survival. Age > 55 years is considered a significant risk factor for a more aggressive and advanced disease with worse outcomes. We identified histopathological factors for disease recurrence in PTC patients younger and older than 55 years of age. METHODS Data on all patients who underwent thyroid surgery due to PTC between 2006 and 2018 in the Tel Aviv Sourasky Medical Center were retrieved for this retrospective cohort study. Patients with lymph node (LN) metastases were further investigated for preoperative presentation, pathological characteristics, and recurrence. A multivariate analysis was used to detect predictors for recurrence and patient outcome for each age-group. RESULTS Twenty-two of the 183 patients (12%) with PTC who met the inclusion criteria and had sufficient follow-up period sustained recurrence. The predictors of recurrence varied between the two age-groups. The size of thyroid lesions (p = 0.003) was identified as a risk factor in the older group, while the number of metastatic cervical LNs (p = 0.001) and the ratio of metastatic-to-total dissected cervical LNs (p = 0.027) were the main predictors of recurrence for the younger group. CONCLUSION The histopathological factors predictive for disease recurrence differed among PTC patients younger and older than 55 years of age.
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Gangner Y, Bagot d'Arc M, Delin C. The use of self-assembling peptides (PuraStat) for hemostasis in cervical endocrine surgery. A real-life case series of 353 patients. Int J Surg Case Rep 2022; 94:107072. [PMID: 35452943 PMCID: PMC9043638 DOI: 10.1016/j.ijscr.2022.107072] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/26/2022] Open
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Abdelrahim HS, Amer AF, Mikhael Nageeb R. Indocyanine Green Angiography of Parathyroid Glands versus Intraoperative Parathyroid Hormone Assay as a Reliable Predictor for Post Thyroidectomy Transient Hypocalcemia. J INVEST SURG 2022; 35:1484-1491. [PMID: 35450501 DOI: 10.1080/08941939.2022.2066229] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Prediction of postoperative hypocalcemia is a fundamental issue in thyroidectomy. Indocyanine green (ICG) angiography of parathyroid glands is a feasible method to detect the perfusion of parathyroid glands and predict postoperative hypocalcemia. MATERIALS AND METHODS A prospective observational study was conducted at Ain Shams University Hospitals between April 2018 and April 2021. The included cases of total thyroidectomy underwent intraoperative ICG fluorescence angiography to identify the four parathyroid glands and score each gland according to the viability. Patients in which less than four glands were identified were excluded. Intraoperative intact parathyroid hormone (ioPTH) level assay was also measured to compare with ICG in predicting postoperative transient hypocalcemia. RESULTS A total of 134 cases underwent total thyroidectomy during the study period. We could identify the four parathyroid glands in 90 patients, including them in the study. We had postoperative hypocalcemia in 28 cases (31.1%). The diagnostic accuracy of ICG angiography and ioPTH level assay was high and almost similar (82.22% versus 87.78%). Both were higher than the surgeons' diagnostic accuracy of visual inspection (62.22%). CONCLUSIONS ICG angiography of the parathyroid gland is a safe, reliable predictor for postoperative transient hypocalcemia with a high and almost similar accuracy compared to intraoperative parathyroid hormone level.
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Affiliation(s)
- Hossam S Abdelrahim
- Faculty of Medicine, General Surgery Department, Ain Shams University, Cairo, Egypt
| | - Ahmed F Amer
- Faculty of Medicine, General Surgery Department, Ain Shams University, Cairo, Egypt
| | - Ramy Mikhael Nageeb
- Faculty of Medicine, General Surgery Department, Ain Shams University, Cairo, Egypt
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Risk of hematoma after hemithyroidectomy in an outpatient setting: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2022; 279:3755-3767. [PMID: 35294619 PMCID: PMC9249722 DOI: 10.1007/s00405-022-07312-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Abstract
Purpose After thyroid surgery, the overriding concern is the risk of post-thyroid bleeding (PTB). This systematic review and meta-analysis aimed to assess the safety of hemithyroidectomy in an outpatient setting compared to an inpatient setting. The objectives were to (1) find the proportion of PTB in patients scheduled for outpatient hemithyroidectomy, (2) examine if outpatient hemithyroidectomy is clinically safe compared to an inpatient setting and (3) evaluate which selection criteria are most relevant for hemithyroidectomy in an outpatient setting.
Methods A systematic review was conducted using the following databases: MEDLINE (Ovid), EMBASE (Ovid) and the Cochrane Library from inception until September 2021. We included studies reporting on PTB of patients after hemithyroidectomy in an outpatient setting. The risk of bias was assessed using the Newcastle-Ottawa tool. The results were synthesised using Bayesian meta-analysis. Certainty in evidence was assessed using the GRADE approach.
Results This review included 11 cohort studies and 9 descriptive studies reporting solely on outpatients resulting in a total of 46,866 patients. PTB was experienced by 58 of the 9025 outpatients (0.6%) and 415 of the 37,841 inpatients (1.1%). There was no difference between the PTB rate of outpatients and inpatients (RR 0.715 CrI [0.396–1.243]). The certainty of the evidence was very low due to the high risk of bias. Conclusion The risk of PTB in an outpatient setting is very low, and outpatient hemithyroidectomy should be considered clinically safe. The most relevant selection criteria to consider in outpatient hemithyroidectomy are (1) relevant comorbidities and (2) psycho/-social factors. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-022-07312-y.
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van Gerwen M, Alsen M, Alpert N, Sinclair C, Taioli E. Trends for In- and Outpatient Thyroid Cancer Surgery in Older Adults in New York State, 2007-2017. J Surg Res 2022; 273:64-70. [PMID: 35030431 DOI: 10.1016/j.jss.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/22/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND In view of the 2013 American Thyroid Association consensus statement on outpatient thyroidectomy, the present study assessed the trends and factors associated with thyroid cancer surgery setting in older adults, using the New York Statewide Planning and Research Cooperative System database. MATERIALS AND METHODS There were 14,495 patients with surgically treated thyroid cancer in New York State between 2007 and 2017. Trends were plotted over time and stratified by surgery type. Significance of the trend was assessed using the Mann-Kendall test. Multivariable logistic regression was used to assess independent associations with surgical setting. RESULTS The overall outpatient surgery rate significantly increased over time (correlation coefficient 0.82; P < 0.001), for both total thyroidectomy (P < 0.001) and lobectomy (P < 0.001). Factors associated with increased odds of inpatient surgery were medium- and high-volume hospitalization (adjusted odds ratio [ORadj] 2.12, 95% confidence interval [CI] 1.93-2.32; ORadj 1.69, 95% CI 1.55-1.85, respectively) versus low volume, undergoing total thyroidectomy (ORadj 1.75, 95% CI 1.61-1.90), as well as having Medicare insurance (ORadj 1.13, 95% CI 1.02-1.24) versus private insurance. CONCLUSIONS The present study shows that outpatient thyroidectomy is increasingly favored over inpatient thyroidectomy over time in an older patient population. A clear changepoint following 2011 preceded the publication of the American Thyroid Association statement on outpatient thyroidectomy in 2013 and was likely associated with multiple publications reporting safety of outpatient thyroid surgery and clear economic benefits.
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Affiliation(s)
- Maaike van Gerwen
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Mathilda Alsen
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Naomi Alpert
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Catherine Sinclair
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emanuela Taioli
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Guerra-Londono CE, Kim D, Ramirez Manotas MF. Ambulatory surgery for cancer patients: current controversies and concerns. Curr Opin Anaesthesiol 2021; 34:683-689. [PMID: 34456269 DOI: 10.1097/aco.0000000000001049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW This review aims to describe the main concerns and controversies of ambulatory surgery in cancer patients while providing an overview of ambulatory cancer anaesthesia. RECENT FINDINGS Cancer patients can undergo a variety of ambulatory surgeries. The introduction of robotic approach and the implementation of enhanced recovery programmes have allowed patients to avoid hospital admissions after more complex or invasive surgeries. In this context, the anaesthesiologist plays a key role in ensuring that the ambulatory surgical centre or the hospital-based ambulatory department is equipped for the perioperative challenges of the cancer population. Cancer patients tend to be older and with more comorbidities than the general population. In addition, these individuals may suffer from chronic conditions solely because of the cancer itself, or the treatment. Consequently, frailty is not uncommon and should be screened on a routine basis. Regional analgesia plays a key role in the provision of opioid-sparing multimodal analgesia. SUMMARY Neither regional anaesthesia or general anaesthesia have proven to affect the long-term oncological outcomes of cancer patients undergoing ambulatory surgery. In addition, there is insufficient evidence to suggest the use of total intravenous anaesthesia or inhalational anaesthesia over the other to decrease cancer recurrence.
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Affiliation(s)
- Carlos E Guerra-Londono
- Department of Anesthesiology and Perioperative Medicine, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
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The utility of indocyanine green (ICG) for the identification and assessment of viability of the parathyroid glands during thyroidectomy. Updates Surg 2021; 74:97-105. [PMID: 34727341 DOI: 10.1007/s13304-021-01202-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
We conducted this study to evaluate the ability of indocyanine green (ICG) and near infra-red fluorescence (NIRF) camera to aid in the identification and assessment of viability of parathyroid glands during thyroid surgery. A prospective observational study was conducted between May and October 2020 among 50 consecutive patients who underwent total thyroidectomy at a single institution. Parathyroid glands were identified under white light during thyroidectomy following which reconstituted ICG was injected through a peripheral vein and the location of parathyroid glands was confirmed. The perfusion to the parathyroid gland was assessed by documenting the fluorescence intensity score (FIS) and the parathyroid angiogram score (PAS). There was no difference in the number of parathyroid glands seen on visual inspection 147 (73.5%) when compared to under NIRF camera, 146 (73%). Though the rate of postoperative hypoparathyroidism was lower in the cohort with FIS 3 (14.2%) compared to score 2 and 1 (28.5% and 100%, respectively), this was not significant (p = 0.35). A significant correlation was noted between a delayed flow on PAS and the development of post-thyroidectomy hypoparathyroidism (p = 0.01). PAS had a sensitivity of 100%, specificity of 88.6%, NPV of 100% and PPV of 55.6% to predict the development of post-thyroidectomy hypoparathyroidism. In this study, there was no additional benefit of ICG and NIRF camera in the identification of parathyroid glands. However, ICG angiogram seems to be a good adjunct for the intraoperative assessment of the viability of the parathyroid glands and accurately predicts the development of postoperative hypoparathyroidism.
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Gut L, Bernet S, Huembelin M, Mueller M, Baechli C, Koch D, Nebiker C, Schuetz P, Mueller B, Christ E, Ebrahimi F, Kutz A. Sex-Specific Differences in Outcomes Following Thyroidectomy: A Population-Based Cohort Study. Eur Thyroid J 2021; 10:476-485. [PMID: 34950600 PMCID: PMC8647072 DOI: 10.1159/000510618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/28/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Numbers of thyroidectomies and awareness of postoperative quality measures have both increased. Potential sex-specific variations in clinical outcomes of patients undergoing thyroidectomy are controversial. OBJECTIVE The aim of this study was to investigate sex-specific differences in outcomes following thyroidectomy. METHODS This is a population-based cohort study of all adult patients undergoing either hemi- or total thyroidectomy in Switzerland from 2011 to 2015. The primary outcome was all-cause 30-day readmission rate. The main secondary outcomes were intensive care unit (ICU) admission, surgical re-intervention, in-hospital mortality, length of hospital stay (LOS), postoperative calcium disorder, vocal cord paresis, and hematoma. RESULTS Of 16,776 patients undergoing thyroidectomy, the majority of patients undergoing thyroidectomy were female (79%), with a median age of 52 (IQR 42-64) years. Within 30 days after the surgery, male patients had significantly higher rates of hospital readmission (adjusted risk ratio [RR] 1.38; 95% confidence interval [95% CI] 1.11-1.72, p = 0.008) and higher risks for postoperative ICU admission (RR 1.25; 95% CI, 1.09-1.44, p = 0.003) than female patients. There were no significant differences among sexes in the LOS, rates of surgical re-interventions, or in-hospital mortality. While postoperative calcium disorders due to hypoparathyroidism were less prevalent among male patients (RR 0.63; 95% CI, 0.54-0.72, p < 0.001), a 2-fold higher incidence rate of postoperative hematoma was observed (RR 1.93, 95% CI, 1.51-2.46, p < 0.001). CONCLUSIONS Male patients undergoing thyroidectomy have higher 30-day hospital readmission and ICU admission rates. Following surgery, male patients revealed higher rates of neck hematoma, while hypocalcemia was more frequent among female patients.
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Affiliation(s)
- Lara Gut
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Selina Bernet
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Monika Huembelin
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Magdalena Mueller
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Ciril Baechli
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Daniel Koch
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Christian Nebiker
- Department of Surgery, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Emanuel Christ
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Fahim Ebrahimi
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
| | - Alexander Kutz
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
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Cozzaglio L, Monzani R, Zuccarelli A, Cananzi F, Sicoli F, Ruspi L, Quagliuolo V. Quality of life and patient satisfaction in outpatient thyroid surgery. Updates Surg 2021; 74:317-323. [PMID: 34677759 DOI: 10.1007/s13304-021-01190-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
In the last three decades surgeons have begun to perform outpatient thyroid surgery (OTS). Important outcome measures of a day-hospital procedure are the patient's quality of life (QoL) and satisfaction, but information on these issues in the OTS setting is scanty. The aim of this pilot study was to explore how early discharge after thyroidectomy affects patients' QoL and satisfaction. Postoperative QoL and satisfaction were assessed retrospectively by giving each patient a self-report questionnaire specifically created in our center for OTS and derived from the post-discharge surgical recovery (PSR) scale to assess physical and mental well-being. Twenty-three of 24 patients (96%), 16 women and 7 men with a median age of 48 years (range 16-72), completed the questionnaire, answering 92% of the questions. QoL based on this scale gave a median score of 81.8% (range 62-98.8%). No major or minor complications occurred in the study group. Regarding QoL eight patients (35%) reported feeling "tired all the time" and six patients (26%) reported mild pain, which in two cases resolved spontaneously. Regarding patient satisfaction two-thirds of patients judged OTS positively while the remaining one-third would not recommend it. Our study showed very good uptake by patients of a new questionnaire dedicated to OTS as a possible aid in the identification of areas for improvement of OTS management. However, to be considered a safe procedure with maximum patient compliance and satisfaction, OTS was found to require considerable effort by hospital staff and patients' caregivers compared to inpatient thyroid surgery.
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Affiliation(s)
- Luca Cozzaglio
- Department of Surgical Oncology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
| | - Roberta Monzani
- Department of Anesthesiology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Andrea Zuccarelli
- Department of Surgical Oncology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.,Department of General Surgery, Belfast Health and Social Care Trust, Northern Ireland Foundation School, NI Medical and Dental Training Agency (NIMDTA), Belfast, Northern Ireland, UK
| | - Ferdinando Cananzi
- Department of Surgical Oncology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Federico Sicoli
- Department of Surgical Oncology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Laura Ruspi
- Department of Surgical Oncology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Vittorio Quagliuolo
- Department of Surgical Oncology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
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Sessa L, De Crea C, Zotta F, Pia Cerviere M, Gallucci P, Pennestri' F, Princi P, Revelli L, Arcuri G, Bellantone R, Raffaelli M. Post-thyroidectomy hypocalcemia: Is a routine preferable over a selective supplementation? Am J Surg 2021; 223:1126-1131. [PMID: 34711410 DOI: 10.1016/j.amjsurg.2021.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/09/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Comparative studies among protocols for the management of post-total thyroidectomy (TT) hypocalcemia are lacking. We compared the effectiveness of PTH-driven selective supplementation (PD-SS) and routine calcium and calcitriol supplementation with preoperative calcitriol administration in preventing symptomatic hypocalcemia (SH) and readmission. METHODS Three-hundred consecutive patients undergoing TT were assigned to 3 groups: the PD-SS group, the high-dose routine supplementation (HD-RS) group and the low-dose routine supplementation (LD-RS) group. RESULTS Mean post-operative stay was shorter in HD-RS patients when compared to PD-SS and LD-RS (p < 0.001). Significantly more patients in the PD-SS group experienced SH (p = 0.042). The rate of post-operative hypocalcemia was not significantly different among the groups (p = 0.063). No readmission for SH or hypercalcemia occurred. CONCLUSIONS HD-RS emerged as the most effective treatment to prevent SH, without increasing the risk of readmission for calcitriol-related hypercalcemia. Basing on the present results, HD-RS should be recommended as the preferable protocol.
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Affiliation(s)
- Luca Sessa
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carmela De Crea
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale - Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Francesca Zotta
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Milena Pia Cerviere
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Pierpaolo Gallucci
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Pennestri'
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Pietro Princi
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Revelli
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Arcuri
- UOC Tecnologie Sanitarie, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rocco Bellantone
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Raffaelli
- UOC of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale - Università Cattolica del Sacro Cuore, Rome, Italy
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Abstract
PURPOSE OF REVIEW Although traditionally an inpatient procedure, outpatient thyroidectomy has gained traction as a viable and well tolerated alternative for selected patients, with an added benefit of cost savings. RECENT FINDINGS Research on outpatient thyroidectomy has focused on establishing its noninferiority in outcomes compared to the standard inpatient or overnight observation. Numerous studies have found comparable low rates of postoperative complications and no increase in readmission. Selection criteria have been well established by professional societies and research studies support the selection bias benefitting appropriately selected patients. The primary benefit of outpatient thyroidectomy reported is a decrease in cost, though additional theoretical benefits such as decreased exposure to nosocomial infections. SUMMARY Outpatient thyroidectomy is a well tolerated approach in appropriately selected candidates, with cost reduction benefits. Adherence to societal guidelines for patient selection is paramount.
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Fackelmayer OJ, Wu JX, Yeh MW. Endocrine Surgery: Management of Postoperative Complications Following Endocrine Surgery of the Neck. Surg Clin North Am 2021; 101:767-784. [PMID: 34537142 DOI: 10.1016/j.suc.2021.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cervical endocrine operations include parathyroidectomy, thyroid lobectomy, thyroidectomy, central neck dissection, and lateral neck dissection. The vital structures at risk include the recurrent laryngeal nerves to the intrinsic muscles of the larynx, additional cranial nerves, parathyroid glands essential for calcium homeostasis, aerodigestive structures, and great vessels. Here, the authors discuss complications of endocrine neck surgery, including cervical hematoma and other fluid collections, hypocalcemia from hypoparathyroidism, and nerve injuries, along with their prevention, mitigation, and management. Significant and permanent morbidity can result, but fortunately the overall rate of complications remains low, especially when surgery is performed by high-volume surgeons.
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Affiliation(s)
- Oliver J Fackelmayer
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, UCLA Endocrine Center, 100 Medical Plaza Driveway, Suite 310, Los Angeles, CA 90095, USA
| | - James X Wu
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, UCLA Endocrine Center, 100 Medical Plaza Driveway, Suite 310, Los Angeles, CA 90095, USA
| | - Michael W Yeh
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, UCLA Endocrine Center, 100 Medical Plaza Driveway, Suite 310, Los Angeles, CA 90095, USA.
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Association of same-day discharge with hospital readmission after pediatric thyroidectomy. Pediatr Surg Int 2021; 37:1259-1264. [PMID: 34014352 DOI: 10.1007/s00383-021-04927-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Studies have demonstrated that same-day discharge (SDD) following thyroid resection is safe and feasible in adults but there are no similar studies in the pediatric age group. The purpose of this study is to evaluate the influence of SDD on 30-day readmission rates following thyroid surgery in pediatric patients. METHODS This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program-Pediatric database to evaluate 30-day readmission rates among patients < 19 years of age who underwent thyroid resection between 2012 and 2017. Patients excluded were those discharged more than 2 days after surgery. The main exposure variable was SDD and the primary outcome was 30-day readmission. Secondary outcomes included wound complications, unplanned reoperation and death. Patient characteristics were compared using chi-squared testing and odds ratios for readmission were calculated using multivariate logistic regression. RESULTS Of the 1125 patients (79% female, median age 15 years), 122 (11%) were discharged on the day of surgery. Total or near-total thyroidectomy represented the majority of operations (714, 63.5%) and patients undergoing these operations were less likely to be discharged on the same day as surgery compared to those undergoing thyroid lobectomy (4.3 vs. 22.1%, P < 0.001). Twenty-nine patients were readmitted within 30 days (3 in the same day group, 26 in the later group). There was no difference in the odds of readmission between the two groups (adjusted odds ratio in SDD compared to later discharge 1.04 [95% CI 0.29-3.75, P = 0.96; readmission rate, 2.46 vs. 2.59%). Wound complications were reported in two patients, both in the later discharge group. CONCLUSION Same-day discharge in pediatric patients undergoing thyroidectomy is not associated with an increase in 30-day readmissions or wound complications when compared to patients discharged 1 or 2 days after surgery. In selected patients, SDD may be an appropriate alternative to traditional overnight stay.
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Noel CW, Griffiths R, Siu J, Forner D, Urbach D, Freeman J, Goldstein DP, Irish JC, Higgins KM, Devon K, Pasternak JD, Eskander A. A Population-Based Analysis of Outpatient Thyroidectomy: Safe and Under-Utilized. Laryngoscope 2021; 131:2625-2633. [PMID: 34378810 DOI: 10.1002/lary.29816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/23/2021] [Accepted: 08/02/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Performance of thyroidectomy on an outpatient basis has gained popularity although many jurisdictions have not shifted their practice despite a strong safety profile. We sought to assess the uptake and safety of outpatient thyroidectomy in Ontario. STUDY DESIGN Retrospective cohort study. METHODS This was a population-based retrospecive cohort of adult patients undergoing hemithyroidectomy or total thyroidectomy between 1993 and 2017 in Ontario, Canada. Outpatient surgery was defined as discharge home on the same day of surgery. Outcomes of interest include 30-day all cause death, hematoma, emergency department use, and readmission. To adjust for confounding, propensity scores were calculated. Logistic regression models with inverse probability of treatment weighting (IPTW) were then used to estimate the exposure-outcome relationship. RESULTS The final cohort consisted of 81,199 patients: 8,442 underwent same day surgery and 72,757 were admitted. The proportion of patients undergoing outpatient thyroidectomy increased overtime (2.3% in 1993-1994 to 17.8% in 2016-2017). Factors associated with higher odds of outpatient thyroidectomy included: younger age, less material deprivation, less comorbidities, and higher surgeon volume. The absolute number of deaths (≤5) and hematomas (64, 0.8%) in the outpatient cohort was low. After IPTW adjustment, patients with outpatient management had lower odds of neck hematoma (OR 0.73[95CI% 0.58-0.93)], but higher odds of emergency department use (OR 1.67[95%CI 1.56-1.79]). CONCLUSIONS Outpatient thyroidectomy is not associated with an increased mortality risk. Less than one in five patients undergo outpatient thyroidectomy in Ontario, despite a well-established safety profile. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Griffiths
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.,Cancer Care and Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Jennifer Siu
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - David Forner
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.,Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Urbach
- Women's College Hospital and Departments of Surgery and Health Policy, Management and Evaluation, Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy Freeman
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kevin M Higgins
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery, Surgical Oncology, Sunnybrook Health Sciences Centre and Michael Garron Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Karen Devon
- Section of Endocrine Surgery, Division of General Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jesse D Pasternak
- Section of Endocrine Surgery, Division of General Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery, Surgical Oncology, Sunnybrook Health Sciences Centre and Michael Garron Hospital, University of Toronto, Toronto, Ontario, Canada
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AlEssa M, Al-Angari SS, Jomah M, AlOqaili A, Mujammami M, Al-Hakami HA, Al-Dhahri SF. Safety and cost-effectiveness of outpatient thyroidectomy: A retrospective observational study. Saudi Med J 2021; 42:189-195. [PMID: 33563738 PMCID: PMC7989291 DOI: 10.15537/smj.2021.2.25686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/30/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES 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 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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Affiliation(s)
- Mohammed AlEssa
- From the Department of Otolaryngology - Head & Neck Surgery (AlEssa, Al-Angari, Jomah, Al-Dhahri), College of Medicine; from the Division of Endocrinology and Metabolism, Department of Medicine (Mujammami), King Saud University; from the Department of Otolaryngology - Head & Neck Surgery (AlEssa), King Abdulaziz Medical City, National Guard Health Affairs; from the Division of Otolaryngology - Head & Neck Surgery, Department of Surgery (AlOqaili), King Abdullah bin Abdulaziz University Hospital; from the Department of Otolaryngology - Head & Neck Surgery (Al-Dhahri), King Fahad Medical City, Riyadh; and from the Department of Otolaryngology - Head & Neck Surgery (Al-Hakami), College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.
| | - Samiah S. Al-Angari
- From the Department of Otolaryngology - Head & Neck Surgery (AlEssa, Al-Angari, Jomah, Al-Dhahri), College of Medicine; from the Division of Endocrinology and Metabolism, Department of Medicine (Mujammami), King Saud University; from the Department of Otolaryngology - Head & Neck Surgery (AlEssa), King Abdulaziz Medical City, National Guard Health Affairs; from the Division of Otolaryngology - Head & Neck Surgery, Department of Surgery (AlOqaili), King Abdullah bin Abdulaziz University Hospital; from the Department of Otolaryngology - Head & Neck Surgery (Al-Dhahri), King Fahad Medical City, Riyadh; and from the Department of Otolaryngology - Head & Neck Surgery (Al-Hakami), College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.
| | - Mohammed Jomah
- From the Department of Otolaryngology - Head & Neck Surgery (AlEssa, Al-Angari, Jomah, Al-Dhahri), College of Medicine; from the Division of Endocrinology and Metabolism, Department of Medicine (Mujammami), King Saud University; from the Department of Otolaryngology - Head & Neck Surgery (AlEssa), King Abdulaziz Medical City, National Guard Health Affairs; from the Division of Otolaryngology - Head & Neck Surgery, Department of Surgery (AlOqaili), King Abdullah bin Abdulaziz University Hospital; from the Department of Otolaryngology - Head & Neck Surgery (Al-Dhahri), King Fahad Medical City, Riyadh; and from the Department of Otolaryngology - Head & Neck Surgery (Al-Hakami), College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.
| | - Aqeel AlOqaili
- From the Department of Otolaryngology - Head & Neck Surgery (AlEssa, Al-Angari, Jomah, Al-Dhahri), College of Medicine; from the Division of Endocrinology and Metabolism, Department of Medicine (Mujammami), King Saud University; from the Department of Otolaryngology - Head & Neck Surgery (AlEssa), King Abdulaziz Medical City, National Guard Health Affairs; from the Division of Otolaryngology - Head & Neck Surgery, Department of Surgery (AlOqaili), King Abdullah bin Abdulaziz University Hospital; from the Department of Otolaryngology - Head & Neck Surgery (Al-Dhahri), King Fahad Medical City, Riyadh; and from the Department of Otolaryngology - Head & Neck Surgery (Al-Hakami), College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.
| | - Muhammad Mujammami
- From the Department of Otolaryngology - Head & Neck Surgery (AlEssa, Al-Angari, Jomah, Al-Dhahri), College of Medicine; from the Division of Endocrinology and Metabolism, Department of Medicine (Mujammami), King Saud University; from the Department of Otolaryngology - Head & Neck Surgery (AlEssa), King Abdulaziz Medical City, National Guard Health Affairs; from the Division of Otolaryngology - Head & Neck Surgery, Department of Surgery (AlOqaili), King Abdullah bin Abdulaziz University Hospital; from the Department of Otolaryngology - Head & Neck Surgery (Al-Dhahri), King Fahad Medical City, Riyadh; and from the Department of Otolaryngology - Head & Neck Surgery (Al-Hakami), College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.
| | - Hadi A. Al-Hakami
- From the Department of Otolaryngology - Head & Neck Surgery (AlEssa, Al-Angari, Jomah, Al-Dhahri), College of Medicine; from the Division of Endocrinology and Metabolism, Department of Medicine (Mujammami), King Saud University; from the Department of Otolaryngology - Head & Neck Surgery (AlEssa), King Abdulaziz Medical City, National Guard Health Affairs; from the Division of Otolaryngology - Head & Neck Surgery, Department of Surgery (AlOqaili), King Abdullah bin Abdulaziz University Hospital; from the Department of Otolaryngology - Head & Neck Surgery (Al-Dhahri), King Fahad Medical City, Riyadh; and from the Department of Otolaryngology - Head & Neck Surgery (Al-Hakami), College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.
| | - Saleh F. Al-Dhahri
- From the Department of Otolaryngology - Head & Neck Surgery (AlEssa, Al-Angari, Jomah, Al-Dhahri), College of Medicine; from the Division of Endocrinology and Metabolism, Department of Medicine (Mujammami), King Saud University; from the Department of Otolaryngology - Head & Neck Surgery (AlEssa), King Abdulaziz Medical City, National Guard Health Affairs; from the Division of Otolaryngology - Head & Neck Surgery, Department of Surgery (AlOqaili), King Abdullah bin Abdulaziz University Hospital; from the Department of Otolaryngology - Head & Neck Surgery (Al-Dhahri), King Fahad Medical City, Riyadh; and from the Department of Otolaryngology - Head & Neck Surgery (Al-Hakami), College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia.
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Sheikh Z, Lingamanaicker V, Irune E, Fish B, Jani P. Introducing day case thyroid lobectomy at a tertiary head and neck centre. Ann R Coll Surg Engl 2021; 103:499-503. [PMID: 34192491 DOI: 10.1308/rcsann.2020.7063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Thyroid lobectomy is considered to be a safe day case procedure by the British Association of Day Surgery. However, currently only 5.5% of thyroid surgeries in the UK are undertaken as day cases. We determine if and how thyroid lobectomy with same-day discharge could safely be introduced in our centre. METHODS We analysed all thyroid lobectomy surgeries performed between April 2015 and May 2019. Exclusion criteria included completion surgery, revision surgery, additional procedures and disseminated disease. Outcomes were benchmarked against surgeon-reported complications from the British Association of Endocrine and Thyroid Surgery's 5th National Audit. Additionally, we reviewed the number of patients who met day case criteria currently in use at our hospital to determine accessibility to the service. RESULTS In total, 259 thyroid lobectomy surgeries were undertaken and of these 173 met the inclusion criteria. There was no mortality, return to theatre for evacuation of postoperative haematoma or readmission. There was one postoperative haematoma which was drained at the bedside. Some 47 of the 173 (27.2%) patients met day case criteria currently in use at our centre. CONCLUSIONS Day case surgery provides a cost-effective solution to rising bed pressures and a coherent protocol can optimise patient safety and experience.
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Affiliation(s)
- Z Sheikh
- Cambridge University Hospitals NHS Foundation Trust, UK
| | | | - E Irune
- Cambridge University Hospitals NHS Foundation Trust, UK
| | - B Fish
- Cambridge University Hospitals NHS Foundation Trust, UK
| | - P Jani
- Cambridge University Hospitals NHS Foundation Trust, UK
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Chorath K, Luu N, Go BC, Moreira A, Rajasekaran K. ERAS Protocols for Thyroid and Parathyroid Surgery: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2021; 166:425-433. [PMID: 34126805 DOI: 10.1177/01945998211019671] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Enhanced recovery after surgery (ERAS) protocols are evidenced-based multidisciplinary programs implemented in the perioperative setting to improve postoperative recovery and attenuate the surgical stress response. However, evidence on their effectiveness in thyroid and parathyroid surgery remains sparse. Therefore, our goal was to investigate the clinical benefits and cost-effectiveness of ERAS protocols for the perioperative management of thyroidectomy and parathyroidectomy. DATA SOURCE A systematic review of Medline, Scopus, Embase, and gray literature was performed to identify studies of ERAS or clinical care protocols for thyroidectomy and parathyroidectomy. REVIEW METHODS Two reviewers screened studies using predetermined inclusion criteria. Our primary outcomes included hospital length of stay and hospital costs. Readmission and postoperative complication rates composed our secondary outcomes. Meta-analysis was performed to compare outcomes for patients enrolled in the ERAS protocol versus standard of care. RESULTS A total of 450 articles were identified; 7 (1.6%) met inclusion criteria with a total of 3082 patients. Perioperative components in ERAS protocols varied across the studies. Nevertheless, patients enrolled in ERAS protocols had reduced hospital length of stay (mean difference, -0.64 days [95% CI, -0.92 to -0.37]) and hospital costs (in US dollars; mean difference, -307.70 [95% CI, -346.49 to -268.90]), without an increase in readmission (odds ratio, 0.75 [95% CI, 0.29-1.94]) or complication rates (odds ratio, 1.14 [95% CI, 0.82-1.57]). CONCLUSION There is growing literature supporting the role of ERAS protocols for the perioperative management of thyroidectomy and parathyroidectomy. These protocols significantly reduce hospital length of stay and costs without increasing complications or readmission rates.
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Affiliation(s)
- Kevin Chorath
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Neil Luu
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Beatrice C Go
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alvaro Moreira
- Department of Pediatrics, University of Texas Health-San Antonio, San Antonio, Texas, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Toumi A, DiGennaro C, Vahdat V, Jalali MS, Gazelle GS, Chhatwal J, Kelz RR, Lubitz CC. Trends in Thyroid Surgery and Guideline-Concordant Care in the United States, 2007-2018. Thyroid 2021; 31:941-949. [PMID: 33280499 PMCID: PMC8215427 DOI: 10.1089/thy.2020.0643] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: The American Thyroid Association (ATA) published the 2015 Management Guidelines for patients with thyroid nodules and differentiated thyroid cancer, recommending a shift to less aggressive diagnostic, surgical, and postoperative treatment strategies. At the same time and perhaps related to the new guidelines, there has been a shift to outpatient thyroid surgery. The aim of the current study was to assess physician adherence to these recommendations by identifying and quantifying temporal trends in the rates and indications for thyroid procedures in the inpatient and outpatient settings. Methods: Using the IBM® MarketScan® Commercial database, we identified employer-insured patients in the United States who underwent outpatient and inpatient thyroid surgery from 2007 to 2018. Thyroid surgery was classified as total thyroidectomy (TT), thyroid lobectomy (TL), or a completion thyroidectomy. The surgical indication diagnosis was also determined and classified as either benign or malignant thyroid disease. We compared outpatient and inpatient trends in surgery between benign and malignant thyroid disease both before and after the release of the 2015 ATA guidelines. Results: A total of 220,088 patients who underwent thyroid surgery were included in the analysis. Approximately 80% of TLs were performed in the outpatient setting versus 70% of TTs. Longitudinal analysis showed a statistically significant changepoint for TT proportion occurring in November 2015. The proportion of TT as compared with TL decreased from 80% in September 2015 to 39% by December 2018. For thyroid cancer, there is an increasing trend in performing TL over TT, increasing from 17% in 2015 to 28% by the end of 2018. Conclusions: There was a significant changepoint occurring in November 2015 in the operative and management trends for benign and malignant thyroid disease.
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Affiliation(s)
- Asmae Toumi
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Surgical Oncology, Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine DiGennaro
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Surgical Oncology, Harvard Medical School, Boston, Massachusetts, USA
| | - Vahab Vahdat
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Surgical Oncology, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohammad S. Jalali
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Surgical Oncology, Harvard Medical School, Boston, Massachusetts, USA
| | - G. Scott Gazelle
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Surgical Oncology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jagpreet Chhatwal
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Surgical Oncology, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel R. Kelz
- Department of Surgery, Center for Surgery and Health Economics, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carrie C. Lubitz
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Surgical Oncology, Harvard Medical School, Boston, Massachusetts, USA
- Address correspondence to: Carrie C. Lubitz, MD, MPH, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA 02114, USA
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Zhao Y, Zhang D, Zhou L, Li S, Wang T, Li F, Han Y, Dionigi G, Sun H. Proprieties of adhesive surface arrays to thyroid cartilage for recurrent laryngeal nerve monitoring. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:690. [PMID: 33987388 PMCID: PMC8106000 DOI: 10.21037/atm-21-1229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background To investigate the optimal placement and size of adhesive thyroid cartilage electrodes (ATCEs) placed on the thyroid cartilage in porcine models for evaluating recurrent laryngeal nerve function compared with the other 3 recording electrode types. Methods Four Meishan piglets were used for this study. The electromyogram (EMG) signal stability was detected by intraoperative nerve monitoring (IONM). Best location and size of ATCEs were detected, and the EMG signals from each were compared. Latency data were tested by stimulating the different nerve points, and 6 manipulations of the trachea and endotracheal tube (ET) were applied to test the stability of EMG signals. ET electrodes, needle electrodes, and transcutaneous recording electrodes were simultaneously tested with comparison to ATCEs. Results The optimal placement locations and sizes of ATCEs were determined. The amplitudes and latencies recorded from the ATCEs were consistent with those of the ET electrodes. More anti-interference was observed with the ATCEs than with the ET electrodes in surgical manipulations. ATCEs could be used during intermittent and continuous monitoring in similar fashion to ET electrodes and needle electrodes. Conclusions ATCEs had consistent monitoring function with ET electrodes and needle electrodes. Feasibility, EMG stability, and optimal location and size of ATCEs for IONM were resolved. The EMG profiles from the ATCEs were more stable during surgical manipulations.
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Affiliation(s)
- Yishen Zhao
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Daqi Zhang
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Le Zhou
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Shijie Li
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Tie Wang
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Fang Li
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Yujia Han
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Hui Sun
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
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Deitmer T, Dietz A, Delank KW, Plontke SK, Welkoborsky HJ, Dazert S. [Outpatient Surgery in German ENT]. Laryngorhinootologie 2021. [PMID: 33822330 DOI: 10.1055/a-1418-9745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Currently there is an intense discussion ongoing to enhance and expand outpatient surgery in the ENT in Germany, which is the intention by several politicians. The goal is to achieve a frequency of outpatient surgery comparable to an international level.To achieve this goal, acceptance of outpatient interventions by both, surgeons and patients is required, particularly in regard of equal quality standards and patient safety requirements.In the following review the organization, outcome, quality management and strategies for different ENT outpatient surgery worldwide is analyzed. Basically, outpatient surgery is organized in different ways: office-based-procedures in local anesthesia, procedures in ambulatory surgery center settings as standalone facilities or in connection with and adjacent to a hospital with possible inpatient treatment. Contact and resident times of the patients in the outpatient surgery centers differ between some hours through 23 hours. A deliberated and careful selection of patients which are suitable for outpatient procedures is required and should address comorbidities, medications, social circumstances, health literacy of the patient and its relatives, and distance from home to the hospital. A careful and strict quality management is mandatory which comprises the entire process from patient selection through patient entry, surgery, discharge and postoperative care in a multidisciplinary setting.Zur besseren Lesbarkeit des Textes wird bei geschlechterbezogenen Bezeichnungen die männliche Form benutzt. Es sind jedoch in gleicher Rangfolge auch das jeweilige weibliche Geschlecht oder andere Geschlechtsausprägungen gemeint.
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Affiliation(s)
- Thomas Deitmer
- Deutsche Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie, Bonn, Germany
| | - Andreas Dietz
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Plastische Operationen, Universität Leipzig, Leipzig, Germany
| | - K-Wolfgang Delank
- HNO-Klinik, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen, Germany
| | - Stefan K Plontke
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | - H-J Welkoborsky
- Klinik für HNO-Heilkunde, regionale plastische Chirurgie, Kopf- und Halschirurgie, Klinikum Region Hannover GmbH, Hannover, Germany
| | - Stefan Dazert
- Klinik für HNO-Heilkunde, Kopf- und Hals-Chirurgie, St. Elisabeth-Hospital, Klinikum der Ruhr-Universität Bochum, Germany
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Contini S, Alangari SS. Comment on: Safety and cost-effectiveness of outpatient thyroidectomy: A retrospective observational study. Saudi Med J 2021; 42:457. [PMID: 33795505 PMCID: PMC8128647 DOI: 10.15537/smj.2021.42.4.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Samiah S Alangari
- Department of Otolaryngology - Head & Neck Surgery, College of Medicine, King Saud University Riyadh, Kingdom of Saudi Arabia
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Rosen P, Bailey L, Manickavel S, Gentile C, Grayson J, Buczek E. Ambulatory Surgery vs Overnight Observation for Total Thyroidectomy: Cost Analysis and Outcomes. OTO Open 2021; 5:2473974X21995104. [PMID: 33796809 PMCID: PMC7968034 DOI: 10.1177/2473974x21995104] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/25/2021] [Indexed: 11/26/2022] Open
Abstract
Objective To compare financial impact between patients undergoing ambulatory (same-day discharge) vs overnight admission after total thyroidectomy while showing associated surgical outcomes. Study Design Retrospective review. Setting University of Alabama at Birmingham Medical Center from October 2011 and July 2017. Methods Patients undergoing total thyroidectomy without concurrent procedures were selected for review. Demographics, comorbidities, admission status, postoperative outcomes including minor and major complications, charges, and costs were collected. Admission status was categorized as inpatient (admission to hospital ≥1 night) or outpatient (discharged from the postoperative recovery unit). Costs were obtained from all related hospital, clinic, and emergency department visits at the University of Alabama at Birmingham within 30 days of the original surgery. After statistical analysis, outcomes and costs were compared between inpatient and outpatient total thyroidectomy patients. Results Of 870 total thyroidectomy patients included for analysis, 367 (42.2%) met outpatient criteria. A total of 169 patients (19.4%) had a complication, and only hypocalcemia occurred significantly more in the inpatient group (14.3% vs 9.26%; P < .05). No complications occurred more frequently in the outpatient population. There were no mortalities. There was a statistically significant difference between the total cost of inpatient and outpatient thyroidectomies, with outpatient surgery costing on average $2367.27 less per patient (P < .0001). Conclusion Outpatient total thyroidectomy can lead to cost reduction in highly selected patients who have few comorbidities while remaining safe for the patient.
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Affiliation(s)
- Philip Rosen
- Department of Otolaryngology Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Luke Bailey
- Department of Otolaryngology Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sudhir Manickavel
- Department of Otolaryngology Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christopher Gentile
- Department of Otolaryngology Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jessica Grayson
- Department of Otolaryngology Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Erin Buczek
- Department of Otolaryngology Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Donahue C, Pantel HJ, Yarlagadda BB, Brams D. Does Preoperative Calcium and Calcitriol Decrease Rates of Post-Thyroidectomy Hypocalcemia? A Randomized Clinical Trial. J Am Coll Surg 2021; 232:848-854. [PMID: 33631337 DOI: 10.1016/j.jamcollsurg.2021.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Postoperative hypocalcemia is the most common complication after thyroidectomy. Postoperative supplementation with calcium and calcitriol reduces its occurrence; however, prophylactic preoperative supplementation has not been studied systematically. The primary objective of this study was to determine whether pre- and postoperative calcium and calcitriol supplementation reduces postoperative hypocalcemia after total thyroidectomy compared with postoperative supplementation alone. STUDY DESIGN We conducted a single-institution prospective randomized trial enrolling 82 patients undergoing total thyroidectomy from July 2017 through May 2019. Those undergoing partial thyroidectomy or concurrent planned parathyroidectomy were excluded. The intervention group started calcitriol 0.25 μg po bid and calcium carbonate 1,500 mg po tid 5 days preoperatively and continued postoperatively. The control group started these medications postoperatively. The primary end point was clinical or biochemical hypocalcemia. Secondary outcomes were postoperative calcium levels, need for intervention, length of stay, and readmission. RESULTS Thirty-eight patients were randomized to the intervention group and 44 to the control group. There were 12 episodes of hypocalcemia; 5 (13.2%) in the intervention and 7 (15.9%) in the control group (p = 0.76). No differences were found in secondary outcomes; including postoperative calcium levels at each measured time point, need for intervention (n = 10 [26.3%], n = 15 [34.1%]; p = 0.48), length of stay (mean [SD] 32.3 [15.6] hours, 30.7 [10.5] hours; p = 0.6), or readmissions (n = 0 [0.0%], n = 3 [6.8%]; p = 0.24). CONCLUSIONS Starting supplementation with calcium and calcitriol preoperatively does not reduce postoperative hypocalcemia compared with postoperative supplementation alone after total thyroidectomy. These findings do not support the practice of routine calcium and calcitriol supplementation before total thyroidectomy.
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Affiliation(s)
| | | | | | - David Brams
- Lahey Hospital and Medical Center, Burlington, MA
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