Results of a new study presented at the 2006 annual meeting of the American Academy of Otolaryngology suggest that outpatient thyroid surgery is safe and effective for most patients, and may be preferable to traditional inpatient hospital stays.
The researchers concluded that outpatient procedures were preferable both in that they allowed patients to recuperate at home and that they were less expensive for both patients and insurers. Inpatient procedures were still recommended for patients with especially large thyroid lesions and for those who were infirm or had other ailments.
Inpatient vs. OutpatientTraditionally, surgery to remove the thyroid, known as a thyroidectomy, has entailed at minimum an overnight stay and often as much as 48 to 72 hours of hospitalization, despite the fact that complications are infrequent for thyroid surgery. The longer stays for post-surgical observation have often been justified by concerns about the thyroid's proximity to the laryngeal nerve and airway, in addition to a risk of bleeding. But with a rise in the use of minimally invasive techniques that substantially reduce bleeding, physicians today are increasingly scheduling thyroid surgery as an outpatient procedure.
The approach represents a change for thyroid surgeons who have long debated the benefits of inpatient versus outpatient surgeries.
In 1998, an article in the Journal of Clinical Endocrinology and Metabolism (JCEM) by Dr. Orlo Clark analyzed the risks for patients who had undergone thyroid surgery. The analysis suggested that as many as 94 hemorrhage-related deaths per 100,000 thyroid operations could be prevented if patients were hospitalized overnight instead of being discharged in as little as six hours. But in the same year, another article in JCEM by the late thyroid surgeon Paul LoGerfo seemed to counter that claim. LoGerfo reported that he went from performing 10 outpatient thyroidectomies in 1992 to doing 80 in 1996, with no ill effect. "To this date, I have not had to readmit any patient who was discharged in an outpatient setting," LoGerfo wrote.
A New StudyThe latest take on outpatient thyroidectomy, presented in September 2006 at the 110th Annual Meeting & OTO EXPO of the American Academy of Otolaryngologys Head and Neck Surgery Foundation, seems to confirm LoGerfos observation. The nonrandomized study evaluated patients undergoing thyroidectomy at two Georgia hospitals between December 2004 and October 2005.
Patients were divided into two groups. Those who were admitted and stayed at least overnight were considered inpatients. Outpatients were defined as those discharged directly from the recovery unit. The researchers looked at a number of factors, including the duration of surgery, the time to discharge and the total charges billed to the hospital. During the study period, 91 patients underwent thyroid surgery. Most were female and were an average of 45 years-old. Fifty-two were treated as outpatients, and 39 were given inpatient care (26 stayed overnight, while 13 were admitted for about 3 days). Because a major concern following partial or total thyroidectomy is hypocalcemia, a potentially dangerous drop in calcium levels, all patients were given calcium supplements. Calcium levels were also monitored for three weeks following the surgery.
The study data showed that the duration of surgery, time to discharge, and hospital charges were all significantly lower for outpatients versus inpatients, leading researchers to conclude that, for many patients, outpatient thyroid surgery can be safe and cost-effective. Benefits of outpatient procedures cited by the researchers include:
- Lower cost to both patients and insurers
- Patient recuperation occurs at home, away from possible nosocomial (hospital-acquired) infections
- Oral calcium supplements are effective in preventing calcium deficiency after surgery
- Patients with medical infirmity due to weakness or age
- Patients with coexisting conditions or blood diseases
- Patients who will be undergoing other procedures simultaneously that require admission
- Patients who specifically prefer to be admitted
- Patients with especially large thyroid lesions