John K Peel1, Adrienne L Melck1. 1. From the Faculty of Medicine, University of British Columbia, Vancouver, BC (Peel); and the Department of Surgery, St. Paul's Hospital, Vancouver, B.C. (Melck).
Abstract
BACKGROUND: Minimally invasive parathyroidectomy (MIP) with intraoperative parathyroid hormone monitoring is the most common surgical approach among endocrine surgeons for primary hyperparathyroidism (PHPT). Overnight hospitalization after MIP represents a drain on resources and may be unnecessary. The aim of this study was to determine the safety of same-day discharge after MIP. METHODS: We performed a retrospective cohort study of patients treated for PHPT between August 2010 and July 2015. Patients were stratified by their length of stay in hospital and compared in terms of postoperative complications. RESULTS: During the study period 154 MIPs were performed. Of these, 101 patients were discharged on the day of their surgery (group 1) and the remaining 53 stayed 1 or more days (group 2). Three patients in group 2 required readmission within 30 days of discharge (p = 0.039). Seven patients in group 1 and 1 patient in group 2 visited the emergency department within 30 days of discharge (p = 0.72). Two patients in group 1 experienced persistent or recurrent PHPT (p = 0.55). Patients in group 2 were older than those in group 1 (69 v. 61 yr, p < 0.001) and had a higher mean American Society of Anesthesiologists classification of physical status (2.66 v. 2.24, p < 0.001). CONCLUSION: Same-day discharge after MIP is a safe practice and saves the cost of an overnight stay in hospital. Same-day discharge should be considered for all patients undergoing MIP if there are no clear indications for overnight hospitalization.
BACKGROUND: Minimally invasive parathyroidectomy (MIP) with intraoperative parathyroid hormone monitoring is the most common surgical approach among endocrine surgeons for primary hyperparathyroidism (PHPT). Overnight hospitalization after MIP represents a drain on resources and may be unnecessary. The aim of this study was to determine the safety of same-day discharge after MIP. METHODS: We performed a retrospective cohort study of patients treated for PHPT between August 2010 and July 2015. Patients were stratified by their length of stay in hospital and compared in terms of postoperative complications. RESULTS: During the study period 154 MIPs were performed. Of these, 101 patients were discharged on the day of their surgery (group 1) and the remaining 53 stayed 1 or more days (group 2). Three patients in group 2 required readmission within 30 days of discharge (p = 0.039). Seven patients in group 1 and 1 patient in group 2 visited the emergency department within 30 days of discharge (p = 0.72). Two patients in group 1 experienced persistent or recurrent PHPT (p = 0.55). Patients in group 2 were older than those in group 1 (69 v. 61 yr, p < 0.001) and had a higher mean American Society of Anesthesiologists classification of physical status (2.66 v. 2.24, p < 0.001). CONCLUSION: Same-day discharge after MIP is a safe practice and saves the cost of an overnight stay in hospital. Same-day discharge should be considered for all patients undergoing MIP if there are no clear indications for overnight hospitalization.