Khadra Helmi, Mohamed Salah, Hauch Adam, Carter John, Hu Tian, Kandil Emad
Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
Department of Otolaryngology, Head and Neck Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
Gland Surg. 2017 Aug;6(4):292-301. doi: 10.21037/gs.2017.01.05.
Performance of thyroid surgery as a same day surgery procedure has been a controversial topic. This study aimed to compare the safety and efficacy of outpatient thyroid surgery with inpatient thyroid surgery by meta-analysis of current literature.
Articles were identified from the following keyword searches: outpatient thyroidectomy/thyroid surgery, same day thyroidectomy/thyroid surgery. Outcomes included perioperative complications including recurrent laryngeal nerve (RLN) injury, hypocalcemia, and readmissions. Data were extracted following review of appropriate studies by authors and random effects models were used.
34 potentially relevant publications were identified and 14 studies fulfilled the predetermined inclusion criteria, totaling 10,478 patients, 4,565 of whom were discharged the same day following thyroid surgery. There was no difference in malignancy rate between the two groups (95% CI, 0.84-2.31; P=0.196). Inpatient group were 2.23 times (95% CI, 1.36-3.36; P=0.001) more likely to develop transient RLN injury and 2.32 times (95% CI, 1.06-5.06; P=0.034) more likely to have documented transient hypocalcemia compared to outpatients. Inpatient groups were 2.10 times (95% CI, 1.33-3.33; P=0.002) more likely to have documented other complications. The two groups also had similar readmission rates (95% CI, 0.71-1.41; P=1.000).
Our meta-analysis suggests that discharging selective patients the same day after a thyroid surgery is as safe, feasible, and efficacious as admitting them for observation. Admitting patients after thyroid surgery is associated with higher reported risk of complications.
甲状腺手术作为日间手术的实施一直是一个有争议的话题。本研究旨在通过对当前文献的荟萃分析，比较门诊甲状腺手术与住院甲状腺手术的安全性和有效性。
通过以下关键词搜索确定文章：门诊甲状腺切除术/甲状腺手术、当日甲状腺切除术/甲状腺手术。结果包括围手术期并发症，如喉返神经（RLN）损伤、低钙血症和再入院。作者在对适当研究进行审查后提取数据，并使用随机效应模型。
确定了34篇潜在相关出版物，14项研究符合预定纳入标准，共计10478例患者，其中4565例在甲状腺手术后当日出院。两组之间的恶性肿瘤发生率无差异（95%CI，0.84 - 2.31；P = 0.196）。与门诊患者相比，住院组发生短暂性RLN损伤的可能性高2.23倍（95%CI，1.36 - 3.36；P = 0.001），记录到短暂性低钙血症的可能性高2.32倍（95%CI，1.06 - 5.06；P = 0.034）。住院组记录到其他并发症的可能性高2.10倍（95%CI，1.33 - 3.33；P = 0.002）。两组的再入院率也相似（95%CI，0.71 - 1.41；P = 1.000）。
我们的荟萃分析表明，甲状腺手术后当日让部分患者出院与将他们收住入院观察一样安全、可行且有效。甲状腺手术后收住入院的患者报告的并发症风险更高。
