M R Marohn1, K A LaCivita. 1. Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799, USA.
Abstract
BACKGROUND: Once the decision of perform total/near-total thyroidectomy has been made, common perioperative management strategies include frequent postoperative laboratory determinations, bedside airway adjuncts, and hospital stays of about 3 days. We propose a regimen for safe, cost-effective, short-stay total/near-total thyroidectomy. METHODS: One hundred fifty total/near-total thyroidectomies performed between 1991 and 1994 were studied to test our short-stay thyroidectomy regimen. Patients were admitted the day of operation and observed overnight. Serum calcium values were obtained at 8, 14, and 20 hours after operation. Twenty-three-hour discharge criteria included no wound or airway problems, stable vital signs, tolerance of normal diet and activity, and an upsloping serum calcium curve. RESULTS: Of 150 patients undergoing total/near-total thyroidectomy, 145 (97%) met 23-hour discharge criteria. No deaths (0%) occurred. Overall morbidity (six patients [4%)]) included one (0.7%) patient with postoperative hemorrhage, one (0.7%) patient with recurrent laryngeal nerve injury, three (2%) patients with transient hypocalcemia, and one (0.7%) patient with permanent hypocalcemia. Average length of stay was 1.06 days. CONCLUSIONS: Significant airway and wound problems rarely develop beyond the first 12 to 18 hours after total/near-total thyroidectomy. Serial serum calcium determinations used to construct a three-point calcium curve at 20 hours after operation can reliably and safely identify patients at risk to have clinically significant hypocalcemia. Total/near-total thyroidectomy can be performed safely in a short-stay, 23-hour hospitalization setting with substantial cost savings.
BACKGROUND: Once the decision of perform total/near-total thyroidectomy has been made, common perioperative management strategies include frequent postoperative laboratory determinations, bedside airway adjuncts, and hospital stays of about 3 days. We propose a regimen for safe, cost-effective, short-stay total/near-total thyroidectomy. METHODS: One hundred fifty total/near-total thyroidectomies performed between 1991 and 1994 were studied to test our short-stay thyroidectomy regimen. Patients were admitted the day of operation and observed overnight. Serum calcium values were obtained at 8, 14, and 20 hours after operation. Twenty-three-hour discharge criteria included no wound or airway problems, stable vital signs, tolerance of normal diet and activity, and an upsloping serum calcium curve. RESULTS: Of 150 patients undergoing total/near-total thyroidectomy, 145 (97%) met 23-hour discharge criteria. No deaths (0%) occurred. Overall morbidity (six patients [4%)]) included one (0.7%) patient with postoperative hemorrhage, one (0.7%) patient with recurrent laryngeal nerve injury, three (2%) patients with transient hypocalcemia, and one (0.7%) patient with permanent hypocalcemia. Average length of stay was 1.06 days. CONCLUSIONS: Significant airway and wound problems rarely develop beyond the first 12 to 18 hours after total/near-total thyroidectomy. Serial serum calcium determinations used to construct a three-point calcium curve at 20 hours after operation can reliably and safely identify patients at risk to have clinically significant hypocalcemia. Total/near-total thyroidectomy can be performed safely in a short-stay, 23-hour hospitalization setting with substantial cost savings.
Authors: Bahadir M Güllüoğlu; Manuk N Manukyan; Asim Cingi; Cumhur Yeğen; Rifat Yalin; A Ozdemir Aktan Journal: World J Surg Date: 2005-10 Impact factor: 3.352
Authors: Kathryn Spanknebel; John A Chabot; Mary DiGiorgi; Kenneth Cheung; James Curty; John Allendorf; Paul LoGerfo Journal: World J Surg Date: 2006-05 Impact factor: 3.352