Ambulatory thyroidectomy: recommendations from the Association Francophone de Chirurgie Endocrinienne (AFCE). Investigating current practices.

BACKGROUND: Cervical hematoma with airway compromise is a severe complication that may be rapidly lethal or result in irreversible cerebral anoxia if the hematoma is not urgently decompressed. It is therefore indispensable to know the essential relevant elements as well as predictive criteria for this complication before envisioning ambulatory thyroidectomy.
METHODS: The Association francophone de chirurgie endocrinienne (AFCE) sought to answer several questions raised by the proposal of ambulatory thyroidectomy and to propose recommendations based on a review of the literature, an inquiry sent out to members of the AFCE, and an in-depth research of the medicolegal risks involved, based essentially on jurisprudence. The details scrutinized included preoperative selection criteria, the characteristics of the operation and the basic elements of postoperative surveillance.
CONCLUSIONS: The standard today is at least an overnight hospital stay. In fact, hospital stay can be less than 24h because the risk of cervical compressive hematoma is very unusual beyond this interval. Ambulatory (outpatient) thyroidectomy (0 nights) is possible under certain conditions for highly selected patients according to criteria described in the literature that also define relative contra-indications. In case of life-threatening or functional complications, the surgeon stands first in the line of responsibility. The surgeon must therefore ensure that the patient and family were fully informed of the contra-indications, the normal course of postoperative events, of pertinent elements of postoperative surveillance and of the conditions under which the patient can be safely discharged. The surgeon must also realize that this type of management is time-consuming.