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Allahwasaya A, Wang R, Akhund R, McLeod C, Chen H, Lindeman B, Fazendin J, Gillis A, McMullin JL. Does Graves' Disease Truly Increase the Risk of Complications After Total Thyroidectomy? J Surg Res 2024; 300:127-132. [PMID: 38805845 DOI: 10.1016/j.jss.2024.04.070] [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: 11/03/2023] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION Total thyroidectomy (TTx) has been reported to be more challenging in patients with Graves' disease, especially in those who are hyperthyroid at the time of surgery. Our aim was to compare outcomes in patients undergoing TTx for Graves' disease compared to other thyroid diseases at a large academic institution with high-volume fellowship-trained endocrine surgeons. METHODS In our retrospective analysis from December 2015 to May 2023, patients undergoing TTx for Graves' disease were compared to those undergoing TTx for all other indications excluding advanced malignancy (poorly differentiated thyroid cancer and concomitant neck dissections). Patient demographics, biochemical values, and postoperative outcomes were compared. A subgroup analysis was performed comparing hyperthyroid to euthyroid patients at the time of surgery. RESULTS There were 589 patients who underwent TTx, of which 227 (38.5%) had Graves' disease compared to 362 (61.5%) without. Intraoperatively in Graves' patients, nerve monitoring was used more frequently (65.6% versus 57.1%; P = 0.04) and there was a higher rate of parathyroid autotransplantation (32.0% versus 14.4%; P < 0.01). Postoperatively, transient voice hoarseness occurred less frequently (4.8% versus 13.6%; P < 0.01) and there was no difference in temporary hypocalcemia rates or hematoma rates. In our subgroup analysis, 83 (36%) of Graves' patients were hyperthyroid (thyroid-stimulating hormone < 0.45 and free T4 > 1.64) at the time of surgery and there were no differences in postoperative complications compared to those who were euthyroid. CONCLUSIONS At a high-volume endocrine surgery center, TTx for Graves' disease can be performed safely without significant differences in postoperative outcomes. Hyperthyroid patients demonstrated no differences in postoperative outcomes.
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Affiliation(s)
- Ashba Allahwasaya
- Department of Surgery, University of Alabama at Birmingham, Birmingham Alabama
| | - Rongzhi Wang
- Department of Surgery, University of Alabama at Birmingham, Birmingham Alabama
| | - Ramsha Akhund
- Department of Surgery, University of Alabama at Birmingham, Birmingham Alabama
| | - Chandler McLeod
- Department of Surgery, University of Alabama at Birmingham, Birmingham Alabama
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham Alabama
| | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham Alabama
| | - Jessica Fazendin
- Department of Surgery, University of Alabama at Birmingham, Birmingham Alabama
| | - Andrea Gillis
- Department of Surgery, University of Alabama at Birmingham, Birmingham Alabama
| | - Jessica Liu McMullin
- Department of Surgery, University of Alabama at Birmingham, Birmingham Alabama; Department of Surgery, University of Utah, Salt Lake City, Utah.
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Zhang FG, Ow TJ, Lin J, Smith RV, Schiff BA, DeBiase CA, McAuliffe JC, Bloomgarden N, Mehta V. Complications related to thyroidectomy among patients with hyperthyroidism: Exploring the potential for ambulatory surgery. Head Neck 2024; 46:1094-1102. [PMID: 38270487 DOI: 10.1002/hed.27658] [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: 09/19/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Total thyroidectomy for hyperthyroidism is typically followed by overnight admission to monitor for complications including thyrotoxicosis. Outpatient thyroid surgery is increasingly common, but its safety in patients with hyperthyroidism has not been well studied. METHODS This retrospective study reviewed 183 patients with hyperthyroidism who underwent total thyroidectomy from 2015 to 2022 at one urban, academic center. The main outcomes were rates of thyroid storm, surgical complications, and 30-day ED visits and readmissions. RESULTS Among 183 patients with hyperthyroidism (mean age, 45 ± 14.5 years; 82.5% female), there were no cases of thyroid storm and complications included recurrent laryngeal nerve (RLN) palsy (7.0%), symptomatic hypocalcemia (4.4%), and hematoma (1.6%). ED visits were present in 1.1% and no patients were readmitted. CONCLUSION Total thyroidectomy was not associated with thyroid storm and <6% of patients required inpatient management. Ambulatory total thyroidectomy for hyperthyroidism warrants further consideration through identification of predictive factors for postoperative complications.
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Affiliation(s)
- Faye G Zhang
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Thomas J Ow
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Juan Lin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Richard V Smith
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Bradley A Schiff
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Carolyn A DeBiase
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - John C McAuliffe
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Noah Bloomgarden
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Vikas Mehta
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Wang R, Disharoon M, Song Z, Gillis A, Fazendin J, Lindeman B, Chen H, McMullin JL. Incidental but Not Insignificant: Thyroid Cancer in Patients with Graves Disease. J Am Coll Surg 2024; 238:751-758. [PMID: 38230856 DOI: 10.1097/xcs.0000000000000973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Graves disease is the most common cause of hyperthyroidism in the US. Treatment with antithyroid drugs and radioactive iodine is more commonly used than surgical management with total thyroidectomy (TTx). However, incidentally discovered thyroid cancer (TC) has been described on surgical pathology from patients who underwent surgical treatment of Graves disease, which would be missed with these other treatment strategies. We sought to determine the incidence rate of TC among patients with surgically treated Graves disease. STUDY DESIGN We retrospectively reviewed patients with Graves disease who underwent TTx at a single institution from 2011 to 2023. Pathology reports were reviewed for TC. Patient demographics, preoperative laboratory and radiological evaluations, preoperative medical management, and surgical outcomes were compared between patients with and without incidental TC. RESULTS There were 934 patients, of whom 60 (6.4%) patients had incidentally discovered TC on pathology. The majority (58.3%) of patients had papillary thyroid carcinoma, followed by 33.3% with papillary microcarcinoma. Preoperative ultrasound (US) was obtained in 564 (60.4%) of patients, with 44.3% with nodules, but only 34 (13.7%) of those with nodules had TC on final pathology. Preoperative fine needle aspiration was obtained in 15 patients with TC, and 8 patients (53.3%) were reported as benign lesions, which ultimately had TC on final pathology. There was no difference in sex, race or ethnicity, preoperative medical management, and postoperative outcomes between the 2 groups. CONCLUSIONS Incidental TC was found on surgical pathology in 6.4% of patients undergoing TTx for Graves disease. Preoperative imaging with US and fine needle aspiration were often unreliable at predicting TC. The incidence of TC should not be underestimated when counseling patients on definitive management for Graves disease.
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Affiliation(s)
- Rongzhi Wang
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Mitchell Disharoon
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Zhixing Song
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Andrea Gillis
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Jessica Fazendin
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Brenessa Lindeman
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Herbert Chen
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Jessica Liu McMullin
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
- Department of Surgery, University of Utah, Salt Lake City, UT (McMullin)
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Wu C, Zmijewski P, Akhund R, Song Z, Allahwasaya A, Murcy MA, Fazendin J, Lindeman B, Gillis A, Chen H. Graves' disease: Unveiling a novel etiology of secondary hyperparathyroidism. Am J Surg 2024; 229:182-183. [PMID: 37957045 DOI: 10.1016/j.amjsurg.2023.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023]
Affiliation(s)
- Christopher Wu
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Polina Zmijewski
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ramsha Akhund
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Zhixing Song
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ashba Allahwasaya
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mohammad A Murcy
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jessica Fazendin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrea Gillis
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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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:S0002-9610(24)00135-1. [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] [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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6
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Visenio MR, Reddy S, Sturgeon C, Elaraj DM, Ritter HE, McDow AD, Merkow RP, Bilimoria KY, Yang AD. Emergency department use after outpatient thyroidectomy across three states. Surgery 2024; 175:41-47. [PMID: 37945478 DOI: 10.1016/j.surg.2023.09.027] [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: 03/10/2023] [Revised: 07/27/2023] [Accepted: 09/05/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Although outpatient thyroidectomy has become common, few large-scale studies have examined post-thyroidectomy emergency department use, readmission, and encounters not resulting in readmission, known as "treat-and-release" encounters. We evaluated post-outpatient thyroidectomy emergency department use and readmission and characterized associated factors. METHODS Using the Healthcare Cost and Utilization Project databases, we identified adult outpatient (same-day or <24-hour discharge) thyroidectomies performed in Florida, Maryland, and New York from 2016 to 2017. We identified the procedures linked with emergency department treat-and-release encounters and readmissions within 30 days postoperatively and the factors associated with post-thyroidectomy emergency department use and readmission. RESULTS Of the 17,046 patients who underwent outpatient thyroidectomy at 374 facilities, 7.5% had emergency department treat-and-release encounters and 2.3% readmissions. The most common reasons for emergency department treat-and-release encounters (9.9%) and readmissions (22.2%) were hypocalcemia-related diagnoses. Greater odds of treat-and-release were associated with identifying as non-Hispanic Black (adjusted odds ratio: 1.5, 95% confidence interval: 1.3-1.8) or Hispanic race/ethnicity (adjusted odds ratio: 1.4, 95% CI: 1.1-1.6), having Medicaid insurance (adjusted odds ratio: 2.7, 95% CI: 2.3-3.2), and living in non-metropolitan areas (adjusted odds ratio: 1.6, 95% CI: 1.1-2.2). We observed no associations between these factors and the odds of readmission. CONCLUSION Emergency department use after outpatient thyroidectomy is common. Racial, ethnic, socioeconomic, and geographic disparities are associated with treat-and-release encounters but not readmissions. Standardization of perioperative care pathways, focusing on identifying and addressing specific issues in vulnerable populations, could improve care, reduce disparities, and improve patient experience by avoiding unnecessary emergency department visits after outpatient thyroidectomy.
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Affiliation(s)
- Michael R Visenio
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Northwestern University Feinberg School of Medicine. Chicago, IL
| | - Susheel Reddy
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Cord Sturgeon
- Department of Surgery, Northwestern University Feinberg School of Medicine. Chicago, IL
| | - Dina M Elaraj
- Department of Surgery, Northwestern University Feinberg School of Medicine. Chicago, IL
| | - Hadley E Ritter
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Alexandria D McDow
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Ryan P Merkow
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Northwestern University Feinberg School of Medicine. Chicago, IL
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Anthony D Yang
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
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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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8
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Traill L, Kendall MC, Caramez MP, Apruzzese P, De Oliveira G. Outpatient compared to inpatient thyroidectomy on 30-day postoperative outcomes: a national propensity matched analysis. Perioper Med (Lond) 2023; 12:45. [PMID: 37553707 PMCID: PMC10408051 DOI: 10.1186/s13741-023-00335-x] [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: 05/11/2021] [Accepted: 07/11/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND To address the postoperative outcomes between outpatient and inpatient neck surgery involving thyroidectomy procedures. METHODS A cohort analysis of surgical patients undergoing primary, elective, total thyroidectomy from multiple United States medical institutions who were registered with the American College of Surgeons National Surgical Quality Improvement Program from 2015 to 2018. The primary outcome was a composite score that included any 30-day postoperative adverse event. RESULTS A total of 55,381 patients who underwent a total thyroidectomy were identified comprising of 14,055 inpatient and 41,326 outpatient procedures. A cohort of 13,496 patients who underwent outpatient surgery were propensity matched for covariates with corresponding number of patients who underwent inpatient thyroidectomies. In the propensity matched cohort, the occurrence of any 30-day after surgery complications were greater in the inpatient group, 424 out of 13,496 (3.1%) compared to the outpatient group, 150 out of 13,496 (1.1%), P < 0.001. Moreover, death rates were greater in the inpatient group, 22 out 13,496 (0.16%) compared to the outpatient group, 2 out of 13,496 (0.01%), P < 0.001. Similarly, hospital readmissions occurred with greater frequency in the inpatient group, 438 out of 13,496 (3.2%) compared to the outpatient group, 310 out of 13,496 (2.3%), P < 0.001. CONCLUSION Thyroidectomy procedures performed in the outpatient setting had less rates of adverse events, including serious postoperative complications (e.g., surgical site infection, pneumonia, progressive renal insufficiency). In addition, patients who had thyroidectomy in the outpatient setting had less 30-day readmissions and mortality. Surgeons should recognize the benefits of outpatient thyroidectomy when selecting disposition of patients undergoing neck surgery.
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Affiliation(s)
- Lauren Traill
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA
| | - Mark C Kendall
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA.
| | - Maria Paula Caramez
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA
| | - Patricia Apruzzese
- Department of Anesthesiology, Rhode Island Hospital, Providence, RI, 02903, USA
| | - Gildasio De Oliveira
- Department of Anesthesiology, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA
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9
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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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10
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Gillis A, Obiarinze R, McLeod MC, Zmijewski P, Chen H, Fazendin J, Lindeman B. Time to Symptom Resolution After Total Thyroidectomy for Graves' Disease. J Surg Res 2023; 281:185-191. [PMID: 36179596 PMCID: PMC10496743 DOI: 10.1016/j.jss.2022.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/21/2022] [Accepted: 07/28/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Total thyroidectomy (TT) has been shown to be a safe and effective treatment for Graves' disease. However, the time course for improvement of symptoms has not been defined. METHODS With an institutional review board approval, we prospectively gathered survey data of all patients (n = 79) undergoing TT for Graves' disease at a single institution from 2019 to 2021. After informed consent was obtained, patients completed surveys preoperatively and at 2 wk followed by monthly postoperative visits/phone calls. Patient demographics and survey results were collected and analyzed. Symptom recovery time was evaluated using Kaplan-Meier analysis. RESULTS A total of 50 patients completed the survey on postoperative follow-up (response rate 63%). Average age was 38 y (range 12-80 y) and 88% of patients were female. The most common preoperative symptoms were fatigue (90%) and heat/cold intolerance (88%). Tremor (median time to resolution: 1 wk; interquartile range [IQR] 1-3), diarrhea (median 1 wk [IQR 1-3]), and palpitations (median 1 wk [IQR 1-3]) resolved the most rapidly followed by eye symptoms (median 3 wk [IQR 1-6]), heat/cold intolerance (median 3 wk [IQR 3-30]), memory deficits (median 3 wk [IQR 1-undefined]), and fatigue (median: 3 wk [IQR 1-14]). There were no significant differences in time to resolution of symptoms by gender or age (less than versus 40 y and older). Those with uncontrolled Graves' had more severe symptoms but no difference in time to resolution from the euthyroid Graves' patients. CONCLUSIONS Many Graves' disease symptoms improve rapidly following TT, with a median time to improvement of less than 1 mo.
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Affiliation(s)
- Andrea Gillis
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Ruth Obiarinze
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - M Chandler McLeod
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Polina Zmijewski
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jessica Fazendin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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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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Obiarinze R, Fazendin J, Iyer P, Lindeman B, Chen H. Intraoperative parathyroid hormone measurement facilitates outpatient thyroidectomy in children. Am J Surg 2021; 221:683-686. [PMID: 33648715 DOI: 10.1016/j.amjsurg.2021.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/29/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION We hypothesize that intraoperative parathyroid hormone (ioPTH) measurement after a total thyroidectomy predicts children at risk for hypoparathyroidism and allow for outpatient procedure. METHODS Between 2015 and 2019, we reviewed all patients under the age of 21 undergoing a thyroidectomy (total or lobectomy). Based on the ioPTH concentration, the patients were treated by the following protocol: a) PTH ≥20 pg/mL: no treatment; b) PTH = 10-19 pg/mL: 1000 mg calcium orally TID; c) PTH = 5-9 pg/mL: calcitriol 250 μg orally BID plus 1000 mg calcium orally TID; or d) PTH <5 pg/mL calcitriol 500 μg orally BID plus 1000 mg calcium orally TID. RESULTS Fifty-two patients were included with a median age of 16 (range 6-21 years). Thirty-two patients (62%) had normal PTH (≥10 pg/mL) while 20 (38%) had low PTH levels (<10 pg/mL). Of those patients with low PTH, 60% had normalization of levels within 2 weeks of surgery. CONCLUSIONS Thyroid surgery in children can be performed as an outpatient procedure. The ioPTH measurements and a protocol to treat patients with low PTH assists in safe discharge.
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Affiliation(s)
- Ruth Obiarinze
- University of Alabama at Birmingham Department of Surgery, Boshell Diabetes Building, 1808 7th Avenue South, Birmingham, AL 35233, USA.
| | - Jessica Fazendin
- University of Alabama at Birmingham Department of Surgery, Boshell Diabetes Building, 1808 7th Avenue South, Birmingham, AL 35233, USA
| | - Pallavi Iyer
- University of Alabama at Birmingham Department of Pediatrics, CPII M30, 1600 7th Ave S, Birmingham, AL 35233, USA
| | - Brenessa Lindeman
- University of Alabama at Birmingham Department of Surgery, Boshell Diabetes Building, 1808 7th Avenue South, Birmingham, AL 35233, USA
| | - Herbert Chen
- University of Alabama at Birmingham Department of Surgery, Boshell Diabetes Building, 1808 7th Avenue South, Birmingham, AL 35233, USA.
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13
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Fazendin JM, Smithson M, Asban A, Chen H, Lindeman B. The euthyroid state: An often difficult-to-achieve (and unnecessary?) goal at the time of surgery. Am J Surg 2021; 222:499-500. [PMID: 33726920 DOI: 10.1016/j.amjsurg.2021.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 01/21/2023]
Affiliation(s)
- Jessica M Fazendin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Mary Smithson
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ammar Asban
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Kim ES, Gosain A. Invited commentary for "Outpatient thyroidectomy in the pediatric population". Am J Surg 2020; 219:888-889. [DOI: 10.1016/j.amjsurg.2020.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 03/22/2020] [Indexed: 11/15/2022]
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Chen H. EDITORIAL-From the Editor – in – Chief. Am J Surg 2020; 219:541-542. [DOI: 10.1016/j.amjsurg.2020.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Asban A, Anue A, Xie R, Chen H. Increasing Use of Thyroidectomy as Definitive Treatment for Hyperthyroidism. J Surg Res 2020; 246:435-441. [DOI: 10.1016/j.jss.2019.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/02/2019] [Accepted: 09/13/2019] [Indexed: 01/21/2023]
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17
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Asban A, Dream S, Lindeman B. Is Hyperthyroidism Diagnosed and Treated Appropriately in the United States? Adv Surg 2019; 53:117-129. [PMID: 31327441 DOI: 10.1016/j.yasu.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Ammar Asban
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sophie Dream
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brenessa Lindeman
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA.
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Maizlin II, Chen H, Russell RT. RETRACTED: Factors Affecting Readmission After Pediatric Thyroid Resection: A National Surgical Quality Improvement Program-Pediatric Evaluation. J Surg Res 2019; 243:33-40. [PMID: 31153014 DOI: 10.1016/j.jss.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/16/2019] [Accepted: 05/01/2019] [Indexed: 11/18/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the authors because of an error involving the dataset which doubled the reported sample size, thereby invalidating the analysis. The authors reported this error immediately upon discovering the problem. The authors regret the error.
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Affiliation(s)
- Ilan I Maizlin
- Division of Pediatric Surgery, Children's Hospital of Alabama, University of Alabama, Birmingham, Alabama
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert T Russell
- Division of Pediatric Surgery, Children's Hospital of Alabama, University of Alabama, Birmingham, Alabama
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Smithson M, Asban A, Miller J, Chen H. Considerations for Thyroidectomy as Treatment for Graves Disease. CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2019; 12:1179551419844523. [PMID: 31040734 PMCID: PMC6482648 DOI: 10.1177/1179551419844523] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 11/16/2022]
Abstract
Hyperthyroidism is a clinical state that results from abnormally elevated thyroid hormones. Thyroid gland affects many organ systems; therefore, patients usually present with multiple clinical manifestations that involve many organ systems such as the nervous, cardiovascular, muscular, and endocrine system as well as skin manifestations. Hyperthyroidism is most commonly caused by Graves disease, which is caused by autoantibodies to the thyrotropin receptor (TRAb). Other causes of hyperthyroidism include toxic multinodular goiter, toxic single adenoma, and thyroiditis. Diagnosis of hyperthyroidism can be established by measurement of thyroid-stimulating hormone (TSH), which will be suppressed with either elevated free T4 and/or T3 (overt hyperthyroidism) or normal free T3 and T4 (subclinical hyperthyroidism). Hyperthyroidism can be treated with antithyroid drugs (ATDs), radioactive iodine (RAI), or thyroidectomy. ATDs have a higher replacement rate when compared with RAI or thyroidectomy. Recent evidence has shown that thyroidectomy is a very effective, safe treatment modality for hyperthyroidism and can be performed as an outpatient procedure. This review article provides some of the most recent evidence on diagnosing and treating patients with hyperthyroidism.
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Affiliation(s)
- Mary Smithson
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ammar Asban
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jason Miller
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Herbert Chen
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL, USA
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Davis JR, Dackiw AP, Holt SA, Nwariaku FE, Oltmann SC. Rapid Relief: Thyroidectomy is a Quicker Cure than Radioactive Iodine Ablation (RAI) in Patients with Hyperthyroidism. World J Surg 2018; 43:812-817. [PMID: 30483883 DOI: 10.1007/s00268-018-4864-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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