Flynn Michael B, Quayyum Mohiuddin, Goldstein Richard E, Bumpous Jeffery M
Division of Surgical Oncology, Department of Surgery, University of Louisville, School of Medicine, Louisville, Kentucky, USA.
Am Surg. 2015 May;81(5):472-7.
Outpatient parathyroid surgery is increasing in frequency especially for patients undergoing minimally invasive operations. From January 1, 2000 to December 31, 2009, 585 operations were performed on patients with untreated primary hyperparathyroidism. Outpatient operations were performed on 43 per cent (249/585), whereas 57 per cent (336/585) were admitted. Comorbidities were present in 63 per cent of outpatients and 72 per cent of inpatients, whereas systemic complications occurred in 0.8 per cent of outpatients and 7 per cent of inpatients. Ninety-four per cent of outpatients were minimally invasive although inpatient procedures were evenly divided. Local complications were low (8% and 6%) in both groups. Using zip codes to determine distance from home to hospital, no differences were noted. Readmission rates were low (<0.5%) and the same in each group. Inpatients longer than 23 hours tended to be older with higher local and systemic complication rates. Over a decade, most patients undergoing same day parathyroid surgery had minimally invasive operations with lower comorbidities and lower systemic complications than inpatients. Minimally invasive and less complex nonminimally invasive operations can safely be performed on an outpatient basis with careful patient selection. Patient with more severe comorbidities and multiple comorbidities are less favorable candidates for outpatient surgery because of a higher risk of systemic complications.
门诊甲状旁腺手术的频率正在增加，尤其是对于接受微创手术的患者。从2000年1月1日至2009年12月31日，对未经治疗的原发性甲状旁腺功能亢进患者进行了585例手术。其中43%（249/585）为门诊手术，57%（336/585）为住院手术。63%的门诊患者和72%的住院患者存在合并症，而门诊患者全身并发症发生率为0.8%，住院患者为7%。94%的门诊手术为微创手术，而住院手术的微创与非微创比例相当。两组的局部并发症发生率均较低（分别为8%和6%）。通过邮政编码确定患者住所与医院的距离，未发现差异。再入院率较低（<0.5%），且两组相同。住院时间超过23小时的患者往往年龄较大，局部和全身并发症发生率较高。在十年间，大多数接受当日甲状旁腺手术的患者接受的是微创手术，与住院患者相比，合并症和全身并发症更少。对于经过仔细挑选的患者，微创和不太复杂的非微创手术可以在门诊安全进行。合并症更严重和合并多种疾病的患者不太适合门诊手术，因为全身并发症风险较高。
