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Outpatient Thyroidectomy: Pros and Cons

Outpatient surgical care has become a commonly employed practice these days. An increasing number of surgeries can be done on an out-patient basis. Thyroidectomy has also adopted this approach and over 4000 such procedures have been performed successfully. The American Thyroid Association (ATA) therefore commissioned the an interdisciplinary Task Force composed of general surgeons, otolaryngologists, and an endocrinologist to develop a consensus statement that helps to define the eligibility criteria for outpatient thyroidectomy. Included were surgeons who undertook outpatient thyroidectomies, and others who did not. Various factors in providing safe and effective thyroidectomy as an outpatient procedure were explored. Considerations were finalized after healthy participation of the ATA members and members of the American Association of Endocrine Surgeons, the American Head and Neck Society, and the American Academy of Otolaryngology–Head and Neck Surgery. Finally, public opinions were also sought.

Advantages of outpatient thyroidectomy were considered to be a reduced risk for hospital-based infections, reduced costs and increased patient comfort. Iatrogenic complications from extended hospital stay can cause significant morbidity and mortality from methicillin-resistant Staphylococcus aureus, vancomycinresistant enterococcus, or multidrug-resistant tuberculosis infections. A significant reduction in costs has been noted in outpatient thyroidectomy as opposed to the same procedure being conducted as an in-patient procedure. Further, most patients prefer recuperating within the comfort of their home supported by family and friends.

The ATA statement emphasizes interdisciplinary teamwork and precision in following pre-operative, operative and post-operative care to ensure same day discharge of the patient. Local and regional anesthesia could be preferred in this setting. Patients are usually kept for at least 2 hours after thyroidectomy. Healthcare professionals are encouraged to provide all necessary information/education to the patient at discharge in case of emergency in the post-operative period. Ideally, the nearest physician or hospital information should also be provided to the patient, in case complications occur.

Selection of patients for the outpatient procedure is important. This out-patient procedure is not suitable for patients with existing co-morbidities. Additionally, the type of thyroidectomy can dictate which patient is suitable for an out-patient procedure. Unilateral lobectomy has been considered safe as an out-patient procedure. Laryngeal nerve status via monitoring could also influence same day discharge in case a total thyroidectomy was conducted in suitable patients. Routine oral calcium administration (calcium carbonate 1000mg per oval q6–8-hour starting in the recovery room with or without the addition of calcitriol 0.5–1 mcg daily) is advocated in same day discharge patients.

Major postoperative considerations in same-day thyroidectomy are the risks of bleeding, hypocalcemia, nausea, and vomiting, leading to dehydration and an inability to take essential oral medications and pain control. Surgeons who perform high volumes of thyroidectomies are most comfortable with out-patient thyroidectomies compared to other surgeons who prefer their patients for at least an overnight stay.

Terris DJ, et al. for the American Thyroid Association Surgical Affairs Committee Writing Task Force American Thyroid Association Statement on Outpatient Thyroidectomy. THYROID 2013;23(10): 1193-1202.