Type I thyroplasty: risk stratification approach to inpatient versus outpatient postoperative management.

BACKGROUND

type I thyroplasty is an effective and safe procedure for unilateral vocal fold paralysis and is shifting toward outpatient postoperative care. However, serious airway complications have been reported.

OBJECTIVES

the aims of this study were to investigate whether risk stratification into inpatient/outpatient postoperative care reduces outpatient airway complications and to compare the cost-effectiveness and surgical outcomes of risk stratification to a historical inpatient control group (non-risk stratified).

SETTING

tertiary, university-based medical centre.

DESIGN AND RESULTS

Three retrospective groups were examined: historical inpatient control (n = 15), risk-stratified (RS)- inpatient (n = 16), and RS outpatient (n = 17). Laryngeal edema was encountered in two historical controls (13.3%), two RS inpatients (12.5%), and one RS outpatient (5.9%). One case of implant extrusion occurred in the RS outpatient group. There was no difference in maximum phonation time or voice-related quality of life between RS versus historical controls (p > .5). The cost savings of risk stratification versus entirely inpatient care was $CAD 633.12/patient. The average duration in hospital for RS inpatient versus RS outpatient was 29.8 and 8.3 hours, respectively.

CONCLUSIONS

postoperative RS may reduce potentially serious outpatient airway complications and cost while improving patient satisfaction.