Rajeev Parameswaran, Sutaria Rupesh, Ezzat Tarek, Mihai Radu, Sadler Gregory P
Department of Endocrine Surgery, National University Hospital, 1E, Kent Ridge Road, Singapore, 119228, Singapore,
World J Surg. 2014 Nov;38(11):2825-30. doi: 10.1007/s00268-014-2673-1.
A recent British Association of Endocrine and Thyroid Surgeons consensus document suggested that day-case thyroidectomy is feasible in a small proportion of patients but has to be balanced against risks. Currently, there is no large reported series of same-day discharge in thyroid and parathyroid surgery from the UK. The aim of this study was to assess the outcomes of day-case thyroid and parathyroid surgery.
We conducted a retrospective study of patients who underwent thyroid or parathyroid surgery between January 2000 and December 2011 at Oxford University Hospitals. The end points analysed were complications in the form of bleeding, hypocalcaemia, wound infection, and seroma.
A total of 2,102 patients (495 males and 1,607 females, age range = 13-90 years) underwent surgery for parathyroid (n = 776) or thyroid (n = 1,326) conditions. The operations included minimally invasive parathyroidectomy (MIP) (n = 331), open parathyroidectomy (n = 445), lobectomy (n = 687), isthmusectomy (n = 23), total thyroidectomy (n = 580) and thyroglossal cyst excision (n = 36). Routine arrangements were in place for consideration of same-day discharge for lobectomies, thyroglossal cyst surgery, and MIPs; lobectomies accounted for 63 % of same-day cases, followed by parathyroidectomy (35 %). Over the decade, day-case surgery increased from 4 to 17 % for thyroid surgery and from 20 to 40 % for parathyroid surgery. None of the 435 patients who had same-day discharge was readmitted for bleeding [confidence interval (CI) 0-0.6 %]. There was no 30-day mortality for the whole cohort. Complications in patients who underwent surgery in the whole cohort versus those who were discharged the same day were temporary hypocalcaemia (4 vs. 0.2 %), permanent hypocalcaemia (1 vs. 0.4 %), bleeding (0.4 vs. 0 %), seroma (0.3 vs. 0 %), and wound infection (0.3 vs. 0 %).
Current protocols for thyroid or parathyroid surgery make same-day discharge feasible and safe in carefully selected patients.
英国内分泌与甲状腺外科医生协会最近的一份共识文件表明，日间甲状腺切除术在一小部分患者中是可行的，但必须权衡风险。目前，英国尚无关于甲状腺和甲状旁腺手术当日出院的大量报道系列。本研究的目的是评估日间甲状腺和甲状旁腺手术的结果。
我们对2000年1月至2011年12月在牛津大学医院接受甲状腺或甲状旁腺手术的患者进行了一项回顾性研究。分析的终点是出血、低钙血症、伤口感染和血清肿形式的并发症。
共有2102例患者（495例男性和1607例女性，年龄范围 = 13 - 90岁）接受了甲状旁腺（n = 776）或甲状腺（n = 1326）疾病的手术。手术包括微创甲状旁腺切除术（MIP）（n = 331）、开放甲状旁腺切除术（n = 445）、叶切除术（n = 687）、峡部切除术（n = 23）、全甲状腺切除术（n = 580）和甲状舌管囊肿切除术（n = 36）。对于叶切除术、甲状舌管囊肿手术和MIPs，常规安排了考虑当日出院；叶切除术占当日病例的63%，其次是甲状旁腺切除术（35%）。在这十年中，甲状腺手术的日间手术从4%增加到17%，甲状旁腺手术从20%增加到40%。435例当日出院的患者中无一因出血再次入院[置信区间（CI）0 - 0.6%]。整个队列无30天死亡率。整个队列接受手术的患者与当日出院患者的并发症分别为暂时性低钙血症（4%对0.2%）、永久性低钙血症（1%对0.4%）、出血（0.4%对0%）、血清肿（0.3%对0%）和伤口感染（0.3%对0%）。
目前的甲状腺或甲状旁腺手术方案使在精心挑选的患者中当日出院可行且安全。
