Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA.
Otolaryngol Head Neck Surg. 2014 May;150(5):770-4. doi: 10.1177/0194599814521568. Epub 2014 Feb 3.
Describe barriers to same-day surgery for patients undergoing total and completion thyroidectomy.
Case series with chart review.
Academic health sciences center.
The subjects were patients who underwent total thyroidectomy or completion thyroidectomy and remained in hospital overnight or longer. A review was performed on patients who were operated on by a single surgeon from July 2005 through June 2013.
Two hundred and sixty-eight cases were planned for same-day surgery. One hundred patients were not discharged on the same day (37%). Patients observed overnight or admitted to hospital had significantly lower postoperative calcium levels, 8.4 mg/dL (P < .0001), and lower intraoperative parathyroid hormone (PTH), mean 6.0 pg/mL (P < .0001). Those significantly more likely to require overnight observation were male patients (P = .0117), black patients (P = .0045), those with completion thyroidectomy (P = .0039), and those with a complication of surgery (P = .003).
Intraoperative PTH less than 10 pg/mL was the most frequent factor (25.7%) precluding same-day discharge, followed by admission for social/financial/transportation reasons (22.6%), large dead space from goiter (15.5%), multiple comorbidities (13.4%), multiple surgical reasons (5.2%), airway observation (5.2%), pain management (3.1%), and intractable nausea due to general anesthetic (2.1%). Hypocalcemia and postoperative bleeding still remain obstacles to outpatient thyroid surgery; however, the use of rapid PTH testing, modern hemostatic techniques, appropriate calcium prophylaxis, and experienced clinical decision making can effectively stratify which patients require overnight observation.
描述行甲状腺全切除术和甲状腺次全切除术患者接受当日手术的障碍。
病例系列及病历回顾。
学术健康科学中心。
研究对象为接受甲状腺全切除术或甲状腺次全切除术且住院过夜或更长时间的患者。对 2005 年 7 月至 2013 年 6 月期间由同一位外科医生进行手术的患者进行了回顾。
268 例计划行日间手术。有 100 例患者未在当日出院（37%）。接受过夜观察或住院治疗的患者术后血钙水平显著较低，为 8.4mg/dL（P<0.0001），且术中甲状旁腺激素（PTH）水平显著较低，平均值为 6.0pg/mL（P<0.0001）。显著更有可能需要过夜观察的是男性患者（P=0.0117）、黑人患者（P=0.0045）、行甲状腺次全切除术的患者（P=0.0039）以及有手术并发症的患者（P=0.003）。
术中 PTH<10pg/mL 是最常见的排除当日出院的因素（25.7%），其次是因社会/经济/交通原因入院（22.6%）、甲状腺肿引起的大死腔（15.5%）、多种合并症（13.4%）、多种手术原因（5.2%）、气道观察（5.2%）、疼痛管理（3.1%）和全身麻醉后顽固性恶心（2.1%）。低钙血症和术后出血仍然是门诊甲状腺手术的障碍；然而，快速 PTH 检测、现代止血技术、适当的钙预防以及经验丰富的临床决策制定可有效地分层哪些患者需要过夜观察。
