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Meers AJ, Warren JD, Dmowska J, Kane AC, Tassone P. Unplanned Return to Hospital After Same Day Oral Cavity Resection: A Dual Institution Study. Ann Otol Rhinol Laryngol 2024; 133:449-453. [PMID: 38321926 DOI: 10.1177/00034894241230355] [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] [Indexed: 02/08/2024]
Abstract
OBJECTIVES Primary objective: describe rates of 30-days unplanned readmission following outpatient resection of oral cavity cancer. Secondary objective: evaluate for patient and treatment factors associated with readmission. METHODS Retrospective, dual-institution cohort study of 2 tertiary care referral centers involving adult patients undergoing resection of oral cavity cancer with plans for same-day discharge. Consecutive sample of 77 patients included. Primary outcome was unplanned readmission to emergency room or inpatient stay in the 30 days following surgery. Comparison testing was used between return and non-return groups. RESULTS Among 77 patients treated with outpatient surgery for oral cavity cancer, 19 (25%) returned to the hospital within 30 days. Among the reasons for return, 16 (80%) were directly related to surgery, and 4 (20%) were related to perioperative medical complications not directly related to a surgical site. Among the 25 patients also undergoing sentinel lymph node biopsy with their oral cavity resection, none returned to the hospital for neck-related complications. While most patients could be safely observed and discharged after return to the hospital, 8 patients (10%) required inpatient readmission. No significant differences between return and non-return groups were identified, although there was a trend toward shorter driving distance from hospital for the return group (47.6 miles vs. 69.5 miles, P = 0.097). CONCLUSION Unplanned return to the hospital following outpatient oral cavity resection is prevalent and primarily driven by postoperative primary resection site concerns. Among patients selected for same day discharge, no definite population at highest risk of unplanned return was identified.
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Affiliation(s)
- Aaron J Meers
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - James D Warren
- Department of Otolaryngology - Head and Neck Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Julia Dmowska
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Anne C Kane
- Department of Otolaryngology - Head and Neck Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Patrick Tassone
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
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Fan KY, Loh EW, Tam KW. Efficacy of HIFU for the treatment of benign thyroid nodules: a systematic review and meta-analysis. Eur Radiol 2024; 34:2310-2322. [PMID: 37792080 DOI: 10.1007/s00330-023-10253-7] [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: 11/10/2022] [Revised: 07/17/2023] [Accepted: 08/03/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Thyroid nodules are common and sometimes associated with cosmetic issues. Surgical treatment has several disadvantages, including visible scarring. High-intensity focused ultrasound (HIFU) is a recent noninvasive treatment for thyroid nodules. The present study aims to evaluate the effectiveness and safety of HIFU for the treatment of benign thyroid nodules. METHODS We searched PubMed, Embase, and Cochrane Library for studies evaluating the outcomes of HIFU for patients with benign thyroid nodules. We conducted a meta-analysis by using a random effects model and evaluated the volume reduction ratio, treatment success rate, and incidence of treatment-related complications. RESULTS Thirty-two studies were included in the systematic review. Only 14 studies were used in the meta-analysis because the other 18 involved data collected during overlapping periods. The average volume reduction ratios at 3, 6, and 12 months after treatment were 39.02% (95% CI: 27.57 to 50.47%, I2: 97.9%), 48.55% (95% CI: 35.53 to 61.57%, I2: 98.2%), and 55.02% (95% CI: 41.55 to 68.48%, I2: 99%), respectively. Regarding complications, the incidences of vocal cord paresis and Horner's syndrome after HIFU were 2.1% (95% CI: 0.2 to 4.1%, I2: 14.6%) and 0.7% (95% CI: 0 to 1.9%, I2: 0%), respectively. CONCLUSIONS HIFU is an effective and safe treatment option for patients with benign thyroid nodules. However, the effects of HIFU on nodules of large sizes and with different properties require further investigation. Additional studies, particularly randomized controlled trials involving long-term follow-up, are warranted. CLINICAL RELEVANCE STATEMENT Surgical treatment for thyroid nodules often results in permanent visible scars and is associated with a risk of bleeding, nerve injury, and hypothyroidism. High-intensity focused ultrasound may be an alternative for patients with benign thyroid nodules. KEY POINTS • The success rate of HIFU treatment for thyroid nodules is 75.8% at 6 months. Average volume reduction ratios are 48.55% and 55.02% at 6 and 12 months. • The incidence of complications such as vocal fold paresis, Horner's syndrome, recurrent laryngeal nerve palsy, hypothyroidism, and skin redness is low. • HIFU is both effective and safe as a treatment for benign thyroid nodules.
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Affiliation(s)
- Kang-Yun Fan
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - El-Wui Loh
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Medical Imaging, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ka-Wai Tam
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan.
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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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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Song C, Luo JY, Pang YY, He RQ, Li XJ, Chen G, Zhao CY, Qu N, Chen YM, Yang L, Li BQ, Shi L. Historical context, process, and development trends of pediatric thyroid cancer research: a bibliometric analysis. Front Oncol 2024; 14:1340872. [PMID: 38463235 PMCID: PMC10921230 DOI: 10.3389/fonc.2024.1340872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/24/2024] [Indexed: 03/12/2024] Open
Abstract
Objective At present, the structure of knowledge in the field of childhood thyroid cancer is not clear enough, and scholars lack a sufficient understanding of the developing trends in this field, which has led to a shortage of forward-looking outputs. The purpose of this research is to help scholars construct a complete knowledge framework and identify current challenges, opportunities, and development trends. Methods We searched the literature in the Web of Science Core Collection database on August 7, 2023 and extracted key information from the top 100 most cited articles, such as the countries, institutions, authors, themes, and keywords. We used bibliometric tools such as bibliometrix, VOSviewer, and CiteSpace for a visualization analysis and Excel for statistical descriptions. Results The top 100 most cited articles fluctuated over time, and the research was concentrated in European countries, the United States, and Japan, among which scientific research institutions and scholars from the United States made outstanding contributions. Keyword analysis revealed that research has shifted from simple treatment methods for pediatric thyroid cancer (total thyroidectomy) and inducing factors (the Chernobyl power station accident) to the clinical applications of genetic mutations (such as the BRAF and RET genes) and larger-scale genetic changes (mutation studies of the DICER1 gene). The thematic strategy analysis showed an increasing trend towards the popularity of fusion oncogenes, while the popularity of research on traditional treatments and diagnostics has gradually declined. Conclusion Extensive research has been conducted on the basic problems of pediatric thyroid cancer, and there has been significant outputs in the follow-up and cohort analysis of conventional diagnostic and treatment methods. However, these methods still have certain limitations. Therefore, scholars should focus on exploring fusion genes, the clinical applications of molecular targets, and novel treatment methods. This study provides a strong reference for scholars in this field.
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Affiliation(s)
- Chang Song
- Department of Pathology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jia-Yuan Luo
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yu-Yan Pang
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Rong-Quan He
- Department of Medical Oncology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiao-Jiao Li
- Department of Nuclear Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Gang Chen
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chun-Yan Zhao
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ning Qu
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan-Mei Chen
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Li Yang
- Department of Pathology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bi-Qi Li
- Department of Pathology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lin Shi
- Department of Pathology, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
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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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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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7
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Abraham PJ, Wang R, Bahl D, Bhambhvani P, Ho S, Fazendin JM, Chen H, Lindeman BM. Virtual Tumor Board: Papillary thyroid carcinoma with nodal disease. CA Cancer J Clin 2023; 73:555-561. [PMID: 37314110 DOI: 10.3322/caac.21802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/07/2022] [Accepted: 12/21/2022] [Indexed: 06/15/2023] Open
Affiliation(s)
- Peter J Abraham
- General Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rongzhi Wang
- General Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Deepti Bahl
- Endocrinology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pradeep Bhambhvani
- Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Jessica M Fazendin
- General Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Herbert Chen
- General Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brenessa M Lindeman
- General Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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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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Scheller B, Culié D, Poissonnet G, Dassonville O, D'Andréa G, Bozec A. Recent Advances in the Surgical Management of Thyroid Cancer. Curr Oncol 2023; 30:4787-4804. [PMID: 37232819 DOI: 10.3390/curroncol30050361] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/25/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023] Open
Abstract
A growing incidence of differentiated thyroid cancer (DTC) has been reported in most developed countries, corresponding mainly to incidentally discovered small papillary thyroid carcinomas. Given the excellent prognosis of most patients with DTC, optimal therapeutic management, minimizing complications, and preserving patient quality of life are essential. Thyroid surgery has a central role in both the diagnosis, staging, and treatment of patients with DTC. Thyroid surgery should be integrated into the global and multidisciplinary management of patients with DTC. However, the optimal surgical management of DTC patients is still controversial. In this review article, we discuss the recent advances and current debates in DTC surgery, including preoperative molecular testing, risk stratification, the extent of thyroid surgery, innovative surgical tools, and new surgical approaches.
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Affiliation(s)
- Boris Scheller
- Face and Neck University Institute, 31 Av. de Valombrose, 06103 Nice, France
- Antoine Lacassagne Center, 33 Av. de Valombrose, 06189 Nice, France
| | - Dorian Culié
- Face and Neck University Institute, 31 Av. de Valombrose, 06103 Nice, France
- Antoine Lacassagne Center, 33 Av. de Valombrose, 06189 Nice, France
| | - Gilles Poissonnet
- Face and Neck University Institute, 31 Av. de Valombrose, 06103 Nice, France
- Antoine Lacassagne Center, 33 Av. de Valombrose, 06189 Nice, France
| | - Olivier Dassonville
- Face and Neck University Institute, 31 Av. de Valombrose, 06103 Nice, France
- Antoine Lacassagne Center, 33 Av. de Valombrose, 06189 Nice, France
| | - Grégoire D'Andréa
- Face and Neck University Institute, 31 Av. de Valombrose, 06103 Nice, France
- University Hospital Center of Nice, 30 Av. de la Voie Romaine, 06000 Nice, France
| | - Alexandre Bozec
- Face and Neck University Institute, 31 Av. de Valombrose, 06103 Nice, France
- Antoine Lacassagne Center, 33 Av. de Valombrose, 06189 Nice, France
- Faculty of Medecine, Cte D'Azur University, 28 Av. Valrose, 06108 Nice, France
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10
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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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11
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Vitamin D Status in Patients before Thyroidectomy. Int J Mol Sci 2023; 24:ijms24043228. [PMID: 36834638 PMCID: PMC9963776 DOI: 10.3390/ijms24043228] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
Thyroid neoplasms (tumors) are the most common pathology of the endocrine system that requires surgery, and in most cases changes are benign. The surgical treatment of thyroid neoplasms consists in total, subtotal, or one lobe excision. Our study aimed to assess the concentration of vitamin D and its metabolites in patients before thyroidectomy. The study included 167 patients with thyroid pathology. Before the thyroidectomy procedure calcidiol (25-OHD), calcitriol (1,25-(OH)2D), and vitamin D binding protein (VDBP), as well as basic biochemical parameters, were measured using an enzyme-linked immunosorbent assay kit. Data analysis showed that the cohort of patients has a significant 25-OHD deficiency and proper concentration of 1,25-(OH)2D. Before the surgery, more than 80% of patients have extreme vitamin D deficiency (<10 ng/mL), and only 4% of the study group has proper 25-OHD concentration. Patients undergoing thyroidectomy are exposed to many complications, including calcium reduction. Our research has shown that patients prior to surgery have a marked vitamin D deficiency, an indicator that may affect their subsequent convalescence and prognosis. The results suggest that determination of vitamin D levels prior to thyroidectomy may be useful for potential consideration of supplementation when vitamin D deficiency is marked and needs to be incorporated into the good clinical management of these patients.
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12
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A Parathyroid Hormone-guided Calcium and Calcitriol Supplementation Protocol Reduces Hypocalcemia-related Readmissions Following Total Thyroidectomy. Endocr Pract 2023; 29:260-265. [PMID: 36682414 DOI: 10.1016/j.eprac.2023.01.009] [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] [Received: 11/15/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To determine the effect of a 4 hour postoperative serum parathyroid hormone (PTH) guided calcium and calcitriol supplementation protocol on the incidence of hypocalcemia and hospital readmissions in patients undergoing total thyroidectomy. METHODS This was a single institution, retrospective chart review of patients who underwent total thyroidectomy, 148 had been operated on prior to the protocol implementation and 389 after. Hypocalcemia risk was stratified as low (PTH >30 pg/ml), medium (15-30 pg/ml), and high (<15 pg/ml), using serum PTH values obtained 4 hours postoperatively. Hypocalcemia was defined as a total serum calcium level <8 mg/dl. Baseline demographic and operative characteristics, and postoperative outcome were recorded for both groups. Fisher's exact test or Wilcoxon rank sum test were used to compare the characteristics of the two groups. A multivariable logistic regression model was applied to account for potentially confounding variables. RESULTS Postoperative hypocalcemia occurred significantly less frequently in the protocol group compared to the preprotocol group (10.3% vs. 20.9%, P=.002). The reduction in hypocalcemia in the protocol group was observed both in patients with (16.3% vs. 25.6%) and without (8.4% vs. 19.3%) cervical lymph node dissection. There was a significantly lower incidence of hospital readmission events in the protocol group compared to the preprotocol group (1.0% vs. 4.7%, P=.013). CONCLUSIONS Compared to a historical cohort, a PTH-guided protocol for calcium and calcitriol supplementation significantly reduces postoperative hypocalcemia and hospital readmission rates, in patients undergoing total thyroidectomy.
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13
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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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14
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de la Fuente Bartolomé M, Sánchez de Molina Rampérez ML, García Vasquez C, Vieiro Medina MV, Jiménez de Los Galanes Marchan SF. Management of thyroid and parathyroid surgery in major ambulatory surgery. Cir Esp 2022; 100:601-603. [PMID: 35697241 DOI: 10.1016/j.cireng.2022.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/31/2021] [Indexed: 06/15/2023]
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15
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Vorländer C, Fischer A, Korkusuz H. High intensity focused ultrasound in the therapy of benign thyroid nodules-first German bicentric study with long-term follow-up. Endocrine 2022; 77:112-120. [PMID: 35476180 DOI: 10.1007/s12020-022-03058-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/10/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE The study evaluated high-intensity-focused ultrasound (HIFU) for benign thyroid nodules in terms of efficiency, complication rate, influence of preablative nodule size, parameters influencing the therapeutic success and hormonal-thyroid-function. METHODS Seventy-two patients with 75 nodules were treated with HIFU at 2 centers from 2014-2019. Median nodule volume was 4.4 ml (range 0.33-53). The therapeutic ultrasound probe (EchoPulse THC900888-H) generated 80-90 °C in the target tissue with 87.6-320.3 J per sonication. Nodal volume was measured at baseline and over 12 months after therapy in a retrospective bicentric-study with long-term follow-up. Hormonal-thyroid function (TSH, T3, T4) was measured before and after ablation. Complications were assessed. RESULTS Significant volume reduction (p < 0.05 Wilcoxon-signed-rank test) of thyroid nodules was 38.98% at 3 months, 37.32% at 6 months, 61.54% at 9 months and 60.66% at 12 months. Volume reduction of nodules <3 ml did not differ significantly from nodules >3 ml (p > 0.05 Mann-Whitney test). At 3 months solid nodules had a significant volume reduction of 52.08%, complex nodules of 32.57%, nodules treated under regional anesthesia of 33.07% and under general anesthesia of 49.47%. Hormonal-thyroid function was not influenced significantly by HIFU therapy (p > 0.05 Wilcoxon-signed-rank test). Complication rate was 3.8%. No long-term complications occurred. CONCLUSION Significant volume reduction of thyroid nodules up to 12 months after HIFU was shown. All complications were reversible. Therapy was more efficient in solid than complex nodules and in nodules treated under general anesthesia than with regional anesthesia. Hormonal-thyroid-function was not affected. TRIAL REGISTRAFTION NUMBER 2020-1728-evBO. Date of registration: 16.06.2020. Agency: Ethik-Kommission bei der Landesäztekammer Hessen.
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Affiliation(s)
- Christian Vorländer
- Bürgerhospital Frankfurt, Nibelungenallee 37, 60318, Frankfurt am Main, Hessen, Germany
| | - Anne Fischer
- DZTA - Deutsches Zentrum für Thermoablation e.V., Nibelungenallee 37-41, 60318, Frankfurt am Main, Hessen, Germany.
| | - Hüdayi Korkusuz
- Afyonkarahisar Sağlık Bilimleri Üniversitesi, Zafer Sağlık Külliyesi, Dörtyol Mahallesi 2078 Sokak No: 3, Afyonkarahisar, Turkey
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16
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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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17
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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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18
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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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19
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de la Fuente Bartolomé M, Sánchez de Molina Rampérez ML, García Vasquez C, Vieiro Medina MV, Jiménez de Los Galanes Marchan SF. Management of thyroid and parathyroid surgery in major ambulatory surgery. Cir Esp 2021; 100:S0009-739X(21)00211-6. [PMID: 34158163 DOI: 10.1016/j.ciresp.2021.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 11/29/2022]
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20
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Wide provider variation in cost for thyroidectomy: Potential benefits of standardizing practice? J Surg Res 2021; 267:9-16. [PMID: 34120017 DOI: 10.1016/j.jss.2021.04.040] [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: 06/27/2020] [Revised: 03/30/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE(S) Identifying provider variation in surgical costs could control rising healthcare expenditure and deliver cost-effective care. While these efforts have mostly focused on complex and expensive operations, provider-level variation in costs of thyroidectomy has not been well examined. METHODS We retrospectively evaluated 921 consecutive total thyroidectomies performed by 14 surgeons at our institution between September 2011 and July 2016. Data were extracted from the Change Healthcare Performance Analytics Program. RESULTS Mean patient age was 47.4 ± 0.5 y, 81% were females, 64.7% were Caucasians, and 18.8% were outpatients. The number of thyroidectomies performed by the 14 surgeons ranged from 4 to 597 (mean = 66). The mean costs per provider varied widely from $4,293 to $15,529 (P < 0.001). The mean length of stay was 1d ± .03 with wide variation among providers (0-6 d). Providers whose hospital cost exceeded the institutional mean demonstrated significantly higher anesthesia fees and lab costs (P < 0.001). CONCLUSIONS We found substantial variation in hospital cost among providers for thyroidectomy despite practicing in the same academic institution, with some surgeons spending 3x more for the same operation. Implementing institutional standards of practice could reduce variation and the costs of surgical care.
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21
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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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22
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Cappuccio S, Li Y, Song C, Liu E, Glaser G, Casarin J, Grassi T, Butler K, Magtibay P, Magrina JF, Scambia G, Mariani A, Langstraat C. The shift from inpatient to outpatient hysterectomy for endometrial cancer in the United States: trends, enabling factors, cost, and safety. Int J Gynecol Cancer 2021; 31:686-693. [PMID: 33727220 DOI: 10.1136/ijgc-2020-002192] [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: 11/04/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate trends in outpatient versus inpatient hysterectomy for endometrial cancer and assess enabling factors, cost and safety. METHODS In this retrospective cohort study, patients aged 18 years or older who underwent hysterectomy for endometrial cancer between January 2008 and September 2015 were identified in the Premier Healthcare Database. The surgical approach for hysterectomy was classified as open/abdominal, vaginal, laparoscopic or robotic assisted. We described trends in surgical setting, perioperative costs and safety. The impact of patient, provider and hospital characteristics on outpatient migration was assessed using multivariate logistic regression. RESULTS We identified 41 246 patients who met inclusion criteria. During the time period studied, we observed a 41.3% shift from inpatient to outpatient hysterectomy (p<0.0001), an increase in robotic hysterectomy, and a decrease in abdominal hysterectomy. The robotic hysterectomy approach, more recent procedure (year), and mid-sized hospital were factors that enabled outpatient hysterectomies; while abdominal hysterectomy, older age, Medicare insurance, black ethnicity, higher number of comorbidities, and concomitant procedures were associated with an inpatient setting. The shift towards outpatient hysterectomy led to a $2500 savings per case during the study period, in parallel to the increased robotic hysterectomy rates (p<0.001). The post-discharge 30-day readmission and complications rate after outpatient hysterectomy remained stable at around 2%. CONCLUSIONS A significant shift from inpatient to outpatient setting was observed for hysterectomies performed for endometrial cancer over time. Minimally invasive surgery, particularly the robotic approach, facilitated this migration, preserving clinical outcomes and leading to reduction in costs.
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Affiliation(s)
- Serena Cappuccio
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Woman's, Child's and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Yanli Li
- Global Health Economics and Outcomes Research, Intuitive Surgical Inc, Sunnyvale, California, USA
| | - Chao Song
- Global Health Economics and Outcomes Research, Intuitive Surgical Inc, Sunnyvale, California, USA
| | - Emeline Liu
- Global Health Economics and Outcomes Research, Intuitive Surgical Inc, Sunnyvale, California, USA
| | - Gretchen Glaser
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Tommaso Grassi
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristina Butler
- Department of Gynecology, Mayo Clinic, Phoenix, Arizona, USA
| | - Paul Magtibay
- Department of Gynecology, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Giovanni Scambia
- Department of Woman's, Child's and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Andrea Mariani
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Carrie Langstraat
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
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Philteos J, Baran E, Noel CW, Pasternak JD, Higgins KM, Freeman JL, Chiodo A, Eskander A. Feasibility and Safety of Outpatient Thyroidectomy: A Narrative Scoping Review. Front Endocrinol (Lausanne) 2021; 12:717427. [PMID: 34394008 PMCID: PMC8355596 DOI: 10.3389/fendo.2021.717427] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Outpatient thyroid surgery is gaining popularity as it can reduce length of hospital stay, decrease costs of care, and increase patient satisfaction. There remains a significant variation in the use of this practice including a perceived knowledge gap with regards to the safety of outpatient thyroidectomies and how to go about implementing standardized institutional protocols to ensure safe same-day discharge. This review summarizes the information available on the subject based on existing published studies and guidelines. METHODS This is a scoping review of the literature focused on the safety, efficacy and patient satisfaction associated with outpatient thyroidectomies. The review also summarizes and editorializes the most recent American Thyroid Association guidelines. RESULTS In total, 11 studies were included in the analysis: 6 studies were retrospective analyses, 3 were retrospective reviews of prospective data, and 2 were prospective studies. The relative contraindications to outpatient thyroidectomy have been highlighted, including: complex medical conditions, anticipated difficult surgical dissection, patients on anticoagulation, lack of home support, and patient anxiety toward an outpatient procedure. Utilizing these identified features, an outpatient protocol has been proposed. CONCLUSION The salient features regarding patient safety and selection criteria and how to develop a protocol implementing ambulatory thyroidectomies have been identified and reviewed. In conclusion, outpatient thyroidectomy is safe, associated with high patient satisfaction and decreased health costs when rigorous institutional protocols are established and implemented. Successful outpatient thyroidectomies require standardized preoperative selection, clear discharge criteria and instructions, and interprofessional collaboration between the surgeon, anesthetist and same-day nursing staff.
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Affiliation(s)
- Justine Philteos
- Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Elif Baran
- Undergraduate Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Christopher W. Noel
- Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jesse D. Pasternak
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Kevin M. Higgins
- Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Jeremy L. Freeman
- Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Albino Chiodo
- Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Antoine Eskander
- Department of Otolaryngology–Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- *Correspondence: Antoine Eskander,
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Elsamna ST, Suri P, Mir GS, Roden DF, Paskhover B. Evaluating the impact of metabolic syndrome on postoperative thyroidectomy outcomes. Head Neck 2020; 43:1271-1279. [PMID: 33368806 DOI: 10.1002/hed.26588] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/19/2020] [Accepted: 12/17/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Metabolic syndrome (MetS) has previously been linked to increased risk of postoperative morbidity and mortality in other surgical undertakings. Because MetS is a consequence of endocrine dysfunction, and given the thyroid's crucial role in endocrine homeostasis, we sought to evaluate the association between MetS and postoperative outcomes of thyroidectomy. METHODS Data were acquired from the ACS-NSQIP database from years 2005 to 2017. Patients with obesity, diabetes, and hypertension were defined as having MetS. Odds ratios (OR) were obtained for outcomes to quantify risk with multivariate logistic regression. RESULTS Outcomes significantly affected by MetS included overall complication (OR: 2.00), extended postoperative stay (OR: 1.52), medical complication (OR: 1.48), surgical complication (OR: 1.62), and mortality (OR: 2.33). CONCLUSIONS Patients with MetS undergoing thyroidectomy are at increased risk of an increased length of stay, overall complications, and mortality.
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Affiliation(s)
- Samer T Elsamna
- Department of Otolaryngology - Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Pooja Suri
- Department of Otolaryngology - Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Ghayoour S Mir
- Department of Otolaryngology - Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Dylan F Roden
- Department of Otolaryngology - Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Boris Paskhover
- Department of Otolaryngology - Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Fassas S, Mamidi I, Lee R, Pasick L, Benito DA, Thakkar P, Joshi AS, Goodman JF. Postoperative Complications After Thyroidectomy: Time Course and Incidence Before Discharge. J Surg Res 2020; 260:210-219. [PMID: 33360304 DOI: 10.1016/j.jss.2020.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 10/19/2020] [Accepted: 11/01/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although complication rates after thyroidectomy are well described in the literature, the timing of these events is less understood. This study delineates the timeline and risk factors for early adverse events after thyroidectomy. MATERIALS AND METHODS This study included a retrospective review of 161,534 patients who underwent thyroidectomy between 2005 and 2018 using the American College of Surgeons National Surgical Quality Improvement Program database. Time to specific complications was analyzed for all patients undergoing thyroidectomy, with further stratification of hemithyroidectomy and total thyroidectomy cohorts. Univariate analyses were conducted to analyze demographics, preoperative comorbidities, and complications. A multivariate logistic regression model was generated to identify significant risk factors for 7-day postoperative complications. RESULTS The overall complication rate was 3.28%. A majority of complications arose before discharge including the following: blood transfusion (96%), hematoma formation (68%), pneumonia (53%), and cardiac arrest (67%). Approximately 37% of unplanned reoperations occurred before discharge in the hemithyroidectomy versus 63% in the total thyroidectomy cohort. Greater than 65% of mortalities occurred after discharge in both groups. Complications generally occurring within 7 d for the entire cohort included the following: pneumonia (3; 2-8 [median postoperative day; interquartile range]), pulmonary embolism (6; 2-12), cardiac arrest (1; 0-5), myocardial infarction (2; 1-6), blood transfusions (0; 0-1), and hematoma formation (0; 0-2). Superficial surgical site infection (9; 6-16) occurred later. Patients who underwent outpatient surgery had a decreased risk of complications (odds ratio 0.41) in the 7-day postoperative period. CONCLUSIONS Although early complications after thyroidectomy are rare, they have a distinct time course, many of which occur after discharge. However, in selected patients undergoing outpatient thyroidectomy, overall risk of complications is decreased. Understanding timing helps establish better preoperative communication and education to improve postoperative expectations for the provider and patient.
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Affiliation(s)
- Scott Fassas
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia.
| | - Ishwarya Mamidi
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia
| | - Ryan Lee
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia
| | - Luke Pasick
- Department of Otolaryngology, Head & Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Daniel A Benito
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia
| | - Punam Thakkar
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia
| | - Arjun S Joshi
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia
| | - Joseph F Goodman
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia
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Zhang Z, Xia F, Wang W, Jiang B, Yao L, Huang Y, Li X. Ambulatory thyroidectomy is safe and beneficial in papillary thyroid carcinoma: Randomized controlled trial. Head Neck 2020; 43:1116-1121. [PMID: 33247492 DOI: 10.1002/hed.26557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/11/2020] [Accepted: 11/20/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Currently, no randomized controlled trial has been performed to investigate the safety profiles, economic benefit and mental health of ambulatory thyroidectomy in patients with papillary thyroid carcinoma (PTC). METHODS Patients diagnosed with PTC were enrolled in this study and were randomly assigned to ambulatory group and control group. The safety profiles, economic benefit and mental health were investigated. RESULTS Four hundred and eleven patients completed the study. There was no significant difference in demographic or tumor index. The incidence of complications was not significantly different (P = .631). The economic cost was significantly lower (P < .001) and hospitalization was significantly shorter (P < .001) in ambulatory group. No significant difference was shown in depression (P = .758) and stress disorder (P = .390). However, the ambulatory group showed a higher point of anxiety (P < .001). CONCLUSION The ambulatory thyroidectomy is safe in patients with PTC, with significant benefits of economic cost and hospitalization.
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Affiliation(s)
- Zeyu Zhang
- Department of Thyroid Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Fada Xia
- Department of Thyroid Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Wenlong Wang
- Department of Thyroid Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Bo Jiang
- Department of Thyroid Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Lei Yao
- Department of Thyroid Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yun Huang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Xinying Li
- Department of Thyroid Surgery, Xiangya Hospital, Central South University, Changsha, China
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Gorbea E, Goldrich DY, Agarwal J, Nayak R, Iloreta AM. The impact of surgeon volume on total thyroidectomy outcomes among otolaryngologists. Am J Otolaryngol 2020; 41:102726. [PMID: 32979668 DOI: 10.1016/j.amjoto.2020.102726] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/21/2020] [Accepted: 09/08/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate the impact of surgeon volume on total thyroidectomy complications and outcomes among otolaryngologists. MATERIALS AND METHODS This state-wide, multi-hospital retrospective review identified patients who underwent total thyroidectomy (TT) (ICD9-06.4) through the Statewide Planning and Research Cooperative System (SPARCS) between 1995 and 2015. Surgeons were categorized into high (>100), medium (10-99), and low (<10) volume groups and differences in complication rates were analyzed. Statistical analysis employed Spearman's rank correlation, Kruskal-Wallis testing, and chi-squared testing. RESULTS 32,133 TT performed by 1032 otolaryngologists were identified. Overall complication rate in our cohort was 9.83% (CI: 9.48-10.18). The most common complication identified overall was hypocalcemia occurring in 3.85% of cases. Surgeons in the high volume group had a complication rate of 9.6%, compared to 10.0% and 11.6% in the medium and low volume groups. This represents a moderate, but statistically significant difference (rho: -0.4, p < 0.0001; KW p ≤0.0001). When looking at individual complications, temporary tracheostomy rate was higher in the low volume group (5.1%, p = 0.001). Other variables such as advanced age, sex, non-white race, or thyroid malignancy were not predictors of increased complication rates for TT. CONCLUSIONS Otolaryngologists who perform a high volume of total thyroidectomy were found to have overall less perioperative complications than those with less volume. In particular, the risk of temporary tracheostomy is higher among low volume surgeons. These findings are consistent with previous studies of the effect of thyroidectomy volume on surgical complications.
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28
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Benito DA, Pasick LJ, Bestourous D, Thakkar P, Goodman JF, Joshi AS. Outpatient vs inpatient parotidectomy: Systematic review and m
eta‐analysis. Head Neck 2020; 43:668-678. [DOI: 10.1002/hed.26482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/11/2020] [Accepted: 09/21/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Daniel A. Benito
- Division of Otolaryngology – Head and Neck Surgery George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Luke J. Pasick
- Department of Otolaryngology – Head and Neck Surgery University of Miami Miller School of Medicine Miami Florida USA
| | - Daniel Bestourous
- Division of Otolaryngology – Head and Neck Surgery George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Punam Thakkar
- Division of Otolaryngology – Head and Neck Surgery George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Joseph F. Goodman
- Division of Otolaryngology – Head and Neck Surgery George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Arjun S. Joshi
- Division of Otolaryngology – Head and Neck Surgery George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
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29
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Moeller EA, Walker T, F Khan Z, P Parreco J, L Buicko J. Socioeconomic Characteristics of Patients Undergoing Ambulatory Parathyroidectomy and a Comparison of Institutional Charges. Am Surg 2020; 88:668-673. [PMID: 32988223 DOI: 10.1177/0003134820951479] [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: 11/16/2022]
Abstract
BACKGROUND Parathyroidectomy is frequently performed as ambulatory surgery. This study seeks to characterize the socioeconomic factors that may impact the patient selection for outpatient parathyroidectomy. METHODS The 2016 Florida State Inpatient Database (SID) and the 2016 Florida State Ambulatory Surgery Database (SASD) were queried for all patients undergoing parathyroidectomy using the International Classification of Diseases 10 (ICD-10) procedure codes. Univariable comparison and multivariate logistic regression were performed for outpatient versus inpatient parathyroidectomy using all relevant patient and hospital characteristics from the database. RESULTS Seven hundred and sixteen patients underwent parathyroidectomy in Florida in 2016; 322 parathyroidectomies were performed in the ambulatory setting (45.0%). After multivariate logistic regression, patients over age 65 and parathyroidectomies performed at high-volume centers were more likely to be performed at an outpatient center. Those patients who were black, Hispanic, had a Charlson Comorbidity Index ≥3, Medicare, Medicaid, and Self-pay were associated with a decreased likelihood of having an outpatient procedure. DISCUSSION Access to ambulatory parathyroidectomy is more common in patients with private insurance, white ethnicity, and fewer comorbidities.
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Affiliation(s)
- Ellie A Moeller
- 7824 Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL, USA
| | - Tamar Walker
- 7824 Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL, USA
| | - Zahra F Khan
- 7824 Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL, USA
| | - Joshua P Parreco
- 7824 Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL, USA
| | - Jessica L Buicko
- 7824 Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL, USA
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Sulibhavi A, Rubin SJ, Park J, Hashemi S, DePietro JD, Noordzij JP. Preventative and management strategies of hypocalcemia after thyroidectomy among surgeons: An international survey study. Am J Otolaryngol 2020; 41:102394. [PMID: 32035653 DOI: 10.1016/j.amjoto.2020.102394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 01/05/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine international surgeon practice patterns for transient postoperative hypocalcemia in patients undergoing total thyroidectomy. METHODS All member surgeons of the American Thyroid Association and the International Association of Thyroid Surgeons were contacted via email to complete a 20-question survey which included both questions about demographic information and preventing and managing postoperative hypocalcemia after thyroidectomy. Univariate analysis was performed to determine whether providers check preoperative vitamin D levels, postoperative calcium trends and/or PTH to assess for postoperative hypocalcemia. RESULTS A total of 332 surgeons responded to the survey with 72.26% in practice for >10 years and 82.18% performing >50 total thyroidectomies per year. 13.29% of surgeon's surveyed reported that they routinely check preoperative vitamin D levels. Surgeon case volume, type of practice (academic vs non-academic practice), and geographic location in the US were significant predictors of whether surgeons check preoperative Vitamin D levels. International surgeons were significantly more likely to check both postoperative serum Ca and PTH compared to US based surgeons (p < .01). There was no significance difference in practice patterns based on whether the surgeon was a General Surgeon or an Otolaryngologist. CONCLUSIONS Using a questionnaire distributed to both General Surgeons and Otolaryngologists, we demonstrated that there is significant variation in practice patterns between surgeons practicing in the United States and surgeons practicing in other countries, and practice often differs from recommended guidelines.
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31
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The most reliable time point for intact parathyroid hormone measurement to predict hypoparathyroidism after total thyroidectomy with central neck dissection to treat papillary thyroid carcinoma: a prospective cohort study. Eur Arch Otorhinolaryngol 2019; 277:549-558. [DOI: 10.1007/s00405-019-05693-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
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Abstract
Nodules in the thyroid are frequent. Preoperative investigations including fine-needle cytology and ultrasound cannot in all patients rule out malignancy. Thus, surgical excision for histopathologic examination is often needed. In this narrative review, we examine aspects of the surgical management of indeterminate thyroid nodules, using a comprehensive review of the available literature. The authors manually searched PubMed for relevant literature, including recently published guidelines. Hemithyroidectomy without lymph node dissection remains the recommended management in indeterminate thyroid nodules, i.e., the complete removal of one lobe of the thyroid, for indeterminate thyroid nodules, defined as nodules with fine-needle cytology fulfilling the criteria of Bethesda III or IV categories. At surgery, it is important to preserve the recurrent and superior laryngeal nerves, and intraoperative neuromonitoring is a useful adjunct. Recent data also suggest that parathyroid autofluorescent techniques are promising tools for parathyroid preservation. There is still lack of specific preoperative investigations to rule in or out central lymph node metastasis. Intraoperative frozen section of lymph nodes can be valuable, but prophylactic or diagnostic central lymph node dissection is not routinely recommended. Outcomes after thyroid surgery are better with high-volume surgeons and institutions. Surgery is probably best performed by high-volume surgeons in institutions with on-site expert pathologists and with technical adjuncts available for nerve and parathyroid preservation. Day-care surgery may be an option for selected patients.
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Affiliation(s)
- Martin Almquist
- Department of Surgery, Skane University Hospital, Lund, Sweden.,Institution for Clinical Sciences, Lund University, Lund, Sweden
| | - Andreas Muth
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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33
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Echanique KA, Govindan A, Mohamed OM, Sylvester M, Baredes S, Yu-Lan Ying M, Kalyoussef E. Age-Related Trends of Patients Undergoing Thyroidectomy: Analysis of US Inpatient Data from 2005 to 2013. Otolaryngol Head Neck Surg 2019; 160:457-464. [PMID: 30829140 DOI: 10.1177/0194599818825455] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES As the country ages, thyroidectomies can be expected to be performed more frequently among the elderly. In this study, we stratified patients by age to explore demographics and complications of patients undergoing thyroidectomy. STUDY DESIGN Retrospective study with a national database. SETTING Nationwide Inpatient Sample. SUBJECTS AND METHODS A total of 414,079 thyroidectomy cases from 2005 to 2013 were identified. Complications, outcomes, demographics, length of stay, and hospital charges were evaluated among patients and stratified by age into 4 cohorts: younger (<65 years), advanced age (65-74 years), elderly (75-84 years), and superelderly (≥85 years). RESULTS Of 414,079 thyroidectomy cases identified, patients aged <65 years accounted for 75.6% of cases, while those aged 65-74, 75-84, and ≥85 years accounted for 16.3%, 7.2%, and 0.9%, respectively ( P < .001). There was a significant difference in length of stay, total hospital charges, and mortality throughout the different age groups ( P < .001), all trending upward with advancing age. In the aging population, incidence of recurrent laryngeal nerve injury, transfusion of erythrocytes, and acute cardiac complications increased with increasing age ( P < .001), while hypoparathyroidism decreased with age ≥65 but ≤85 years ( P < .001). Patients aged ≥75 years had increased odds of mortality as compared with their younger counterparts ( P < .001). CONCLUSION This study utilized a national database to describe and elucidate trends in older populations undergoing thyroidectomy. Thyroid-related complications, including blood transfusion and recurrent laryngeal nerve injury, increased with increasing patient age. This information will help to guide pre- and postoperative care for aging patients undergoing thyroidectomy.
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Affiliation(s)
- Kristen A Echanique
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Aparna Govindan
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Omar M Mohamed
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Michael Sylvester
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Soly Baredes
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,2 Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Mary Yu-Lan Ying
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Evelyne Kalyoussef
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Siddiqui SH, Singh R, Siddiqui E, Zhao EH, Eloy JA, Baredes S, Park RCW. Outpatient versus inpatient parotidectomy: Comparison of postoperative complication rates. Laryngoscope 2018; 129:655-661. [PMID: 30325503 DOI: 10.1002/lary.27358] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Parotidectomies have become a common outpatient procedure, but their impact on postoperative complications as compared to inpatient procedures has not been evaluated in a multi-institutional study. STUDY DESIGN The aim of this retrospective analysis was to evaluate the differences in outcomes using a standardized cohort of patients undergoing outpatient or inpatient parotidectomies. METHODS The National Surgical Quality Improvement Program database was queried for parotidectomies between 2005 and 2014. Univariate analyses were conducted to compare the outpatient and inpatient cohorts. A propensity-matching algorithm was used to ensure equal distribution of demographics and preoperative comorbidities. RESULTS Among the 4,368 parotidectomies examined, 2,915 (66.7%) were outpatient and 1,453 (33.3%) were inpatient. In the unmatched analysis, the inpatient group had higher rates of smokers (P = < 0.001), hypertension (P = 0.003), and disseminated cancer (P = 0.014). The outpatient group had higher rates of patients under age 40 years (P = 0.015), females (P = 0.016), and American Society of Anesthesiology class 1 and 2 (P = < 0.001). The total work relative value units (RVUs) were 17.01 ± 3.44 for the inpatient cohort and 16.19 ± 3.70 for the outpatient cohort (P = < 0.001). Following propensity matching, 1,352 cases were selected for each cohort, with no significant differences in comorbidities. Total work RVU after matching was 16.90 ± 3.47 for the inpatient group and 16.75 ± 3.44 for the outpatient group (P = .235). The matched inpatient cohort had increased rates of surgical complications (3.1% vs. 1.8%, P = 0.033), pneumonia (0.5% vs. 0.0%, P = 0.016), and overall complications (4.5% vs. 2.6%, P = 0.009). CONCLUSION Outpatient parotidectomies are associated with similar as well as decreased complication rates as compared to inpatient parotidectomies. LEVEL OF EVIDENCE 4 Laryngoscope, 129:655-661, 2019.
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Affiliation(s)
- Sana H Siddiqui
- Department of Otolaryngology-Head and Neck Surgery, Newark, New Jersey, U.S.A
| | - Roshansa Singh
- Department of Otolaryngology-Head and Neck Surgery, Newark, New Jersey, U.S.A
| | - Emaad Siddiqui
- Department of Otolaryngology-Head and Neck Surgery, Newark, New Jersey, U.S.A
| | - Eric H Zhao
- Department of Otolaryngology-Head and Neck Surgery, Newark, New Jersey, U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Newark, New Jersey, U.S.A.,the Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, U.S.A.,the Department of Neurological Surgery, Newark, New Jersey, U.S.A.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Newark, New Jersey, U.S.A.,the Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, U.S.A
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Yang Y, Huang K, Huang Y, Peng L. Assessment of the safety and feasibility of 24-hour hospitalization after thyroidectomy. Can J Physiol Pharmacol 2018; 96:893-897. [PMID: 29842796 DOI: 10.1139/cjpp-2018-0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study assessed the safety and feasibility of 24-hour hospitalization after thyroid surgery. A randomized controlled trial study was performed for 432 patients scheduled for thyroidectomy in Guangdong General Hospital between January 2014 and January 2016. Group A cases (n = 216) were 24-hour hospital stay and group B cases (n = 216) were inpatient. Preoperative patient characteristics and operative characteristics as well surgical complications were evaluated. Two hundred and fourteen patients (99%) of group A were discharged after a 24-hour postoperative observation except 1 patient hospitalized 2 days for persistent nausea after surgery, and 1 patient who was hospitalized for 2 days for fear of the complication after the operation. The complication rates were similar between the 2 groups (9/216, 11/216; P > 0.05) and no one was readmitted for operation. The overall complication rate of 24-hour hospital stay procedure was low, and there were no differences in the rate of complications between these 2 groups. Thyroid surgery with 24-hour hospital stay is feasible and safe by experienced surgeon in a setting of appropriate facility and management protocol.
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Affiliation(s)
- Youcheng Yang
- a Southern Medical University, Guangzhou, Guangdong, China.,b Department of General Surgery, Guangdong General Hospital, Guangzhou, Guangdong, China
| | - Kan Huang
- b Department of General Surgery, Guangdong General Hospital, Guangzhou, Guangdong, China
| | - Yijie Huang
- b Department of General Surgery, Guangdong General Hospital, Guangzhou, Guangdong, China
| | - Lin Peng
- a Southern Medical University, Guangzhou, Guangdong, China.,b Department of General Surgery, Guangdong General Hospital, Guangzhou, Guangdong, China
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McLaughlin EJ, Brant JA, Bur AM, Fischer JP, Chen J, Cannady SB, Chalian AA, Newman JG. Safety of outpatient thyroidectomy: Review of the American College of Surgeons National Surgical Quality Improvement Program. Laryngoscope 2017; 128:1249-1254. [PMID: 28988415 DOI: 10.1002/lary.26934] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/14/2017] [Accepted: 08/29/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate national trends in admission status after thyroidectomy in the United States and to evaluate the factors associated with 30-day unplanned readmission and reoperation. STUDY DESIGN Retrospective review of American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) METHODS: The ACS-NSQIP database was queried for patients who underwent a partial or total thyroidectomy between 2005 and 2014. Outpatient surgery was defined as discharge on the day of surgery. Patient demographic information, unplanned hospital readmission, and reoperation were reviewed. Risk factors were identified using logistic regression modeling. RESULTS A total of 76,604 cases met inclusion criteria as described above. There were 1,473 (1.9%) patients who underwent reoperation and 477 unplanned 30-day readmissions (1.4%) for procedures performed since 2012. There was a significant positive trend in the percentage of thyroidectomy (partial and total) patients who underwent outpatient procedures by year of operation (P < .001). Outpatient procedures were not more likely to have unplanned readmissions or reoperations. Independent patient risk factors for unplanned readmission and reoperation included current dialysis, chronic steroid use, unintentional weight loss, American Society of Anesthesiologists class 3 to 4, and active bleeding disorders. CONCLUSIONS Over the past decade there has been a clear trend toward increasing outpatient thyroid surgery. Thyroidectomy performed as an outpatient was not found to be an independent risk factor for readmission or reoperation. Patients with serious medical comorbidities and active bleeding disorders are at increased risk of unplanned readmission or reoperation and should have their surgery performed on an inpatient basis. LEVEL OF EVIDENCE 2c. Laryngoscope, 128:1249-1254, 2018.
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Affiliation(s)
- Eamon J McLaughlin
- Department of Otorhinolaryngology: Head and Neck Surgery, Hospitals of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Jason A Brant
- Department of Otorhinolaryngology: Head and Neck Surgery, Hospitals of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Andres M Bur
- Department of Otorhinolaryngology: Head and Neck Surgery, Hospitals of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - John P Fischer
- Division of Plastic and Reconstructive Surgery, Hospitals of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Jinbo Chen
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Steven B Cannady
- Department of Otorhinolaryngology: Head and Neck Surgery, Hospitals of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Ara A Chalian
- Department of Otorhinolaryngology: Head and Neck Surgery, Hospitals of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Jason G Newman
- Department of Otorhinolaryngology: Head and Neck Surgery, Hospitals of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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Raspanti C, Porrello C, Augello G, Dafnomili A, Rotolo G, Randazzo A, Falco N, Fontana T, Tutino R, Gulotta G. 23-hour observation endocrine neck surgery: lessons learned from a case series of over 1700 patients. G Chir 2017; 38:15-22. [PMID: 28460198 DOI: 10.11138/gchir/2017.38.1.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although the surgical procedures concerning the thyroid and the parathyroid glands are considered safe, the possible occurrence of complications (mainly hematoma and hypocalcemia) limit the short stay surgery. At our institution a 23-hour-surgery with overnight hospital stay for endocrine neck surgical procedures was introduced since 2004. The present case series analyses the institutional results. Over 1913 endocrine neck surgery procedures, 1730 patients (90,2%) were managed according to this model. Among these patients, 92 suffered from hypocalcemia, 12 from airways obstruction due to the hematoma, 5 from bilateral nerve palsy. 15 more patients had unpredictable general disease compromising the short-stay surgery management. The goal of the discharge after 23 hours was achieved in 92,8% of cases with a mean hospital stay of 1,1days. The 23-hour observation with an overnight surgery is feasible and safe if the correct indications are observed. A considerable volume of specific activity is needed.
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Caulley L, Johnson-Obaseki S, Luo L, Javidnia H. Risk factors for postoperative complications in total thyroidectomy: A retrospective, risk-adjusted analysis from the National Surgical Quality Improvement Program. Medicine (Baltimore) 2017; 96:e5752. [PMID: 28151852 PMCID: PMC5293415 DOI: 10.1097/md.0000000000005752] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Thyroid cancer incidence is increasing, and with it, an increase in total thyroidectomy. There are limited studies comparing outcomes in total thyroidectomy performed in the inpatient versus outpatient setting.The objective of this study was to perform a comparative analysis of risk factors and outcomes of postoperative morbidity and mortality in total thyroidectomy performed as an inpatient versus outpatient surgery.Retrospective cohort study of data from the 2005 to 2014 multi-institutional, risk-adjusted American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. A multivariate regression model with corresponding odds ratios and 95% confidence intervals was used to determine 30-day morbidity and mortality after total thyroidectomies, and also risk factors of postoperative outcomes.From 2005 to 2014, 40,025 total thyroidectomies were performed (48.5% inpatient, 51.5% outpatient). The 30-day complication rate for all total thyroidectomies was 7.74%. Multivariate logistic regression analysis was performed to control for potential confounding variables. Preoperative factors that affected complications rates for inpatient thyroidectomies included: age ≥70, non-Caucasian race, dependent functional status, history of congestive heart failure, smoking history, bleeding disorder, wound infection, and preoperative sepsis (P < 0.05). In addition, preoperative factors affecting complications in thyroidectomy performed as an outpatient surgery included malignant thyroid pathology (P 0.05).We identified a subset of preoperative conditions that affect risk of complications after total thyroidectomy. Recommendations for patient selection for outpatient total thyroidectomies should be modified to account for pre-existing conditions that increase the risk of postoperative morbidity.
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Affiliation(s)
- Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa
- The Ottawa Hospital
| | | | - Lindy Luo
- Department of Undergraduate Medical Education, University of Ottawa, Ottawa, Ontario, Canada
| | - Hedyeh Javidnia
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa
- The Ottawa Hospital
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