Bansal Naval, Yadav Sanjay Kumar, Mishra Saroj Kanta, Kishore Kamal, Mishra Anjali, Chand Gyan, Agarwal Gaurav, Agarwal Amit, Verma Ashok Kumar
Consultant Breast and Endocrine Surgeon, Fortis Healthcare, Mohali, India.
Senior Resident, Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226 014, India.
J Thyroid Res. 2018 Aug 5;2018:4910961. doi: 10.1155/2018/4910961. eCollection 2018.
The concept of short stay thyroidectomy has been tested and in practice in the developed world; the same has not been replicated in countries with limited resources due to lack of organized healthcare system. So, in this study, we tried to analyze if short stay thyroid surgery can be performed in a cost-effective way in developing countries and also if the endocrine surgical trainee can deliver these services safely.
The study was conducted prospectively from January 2013 to July 2014, at Department of Endocrine Surgery, SGPGIMS, Lucknow, India. Study group included patients undergoing short stay hemithyroidectomy whereas matched patients who qualified for inclusion criteria but did not undergo short stay surgery due to various reasons constituted control group. Outcome in both the groups was compared in terms of complication rates, cost benefit, and patient satisfaction. Subgroup analysis was also done for trainee versus consultant performed short stay thyroid surgery.
A total of 439 patients with surgical thyroid disorders were evaluated at our institute during the study period and out of these 110 patients (58 cases and 52 controls) fulfilled the inclusion criteria. Younger patients with low socioeconomic status who were paying out of pocket were found to be more inclined to short stay thyroid surgery. There was no significant difference between the two groups in terms of postanesthetic discharge score (PADS), complication rates, and patients satisfaction; however there was significant reduction (p <0.001) in hospital cost in short stay group. In subgroup analysis, procedure time was more in trainee performed surgeries; however there was no significant difference in terms of mean PADS and complication rates.
Short stay thyroidectomy can provide a better cost-effective alternative to conventional thyroidectomy in patients undergoing thyroid surgery and can be safely performed by endocrine surgical trainees even in a low resource setting.
短期住院甲状腺切除术的概念已在发达国家得到验证并付诸实践；由于缺乏有组织的医疗保健系统，资源有限的国家尚未效仿。因此，在本研究中，我们试图分析在发展中国家能否以具有成本效益的方式开展短期住院甲状腺手术，以及内分泌外科实习生能否安全地提供这些服务。
本研究于2013年1月至2014年7月在印度勒克瑙市SGPGIMS内分泌外科进行。研究组包括接受短期住院半甲状腺切除术的患者，而符合纳入标准但因各种原因未接受短期住院手术的匹配患者组成对照组。比较两组在并发症发生率、成本效益和患者满意度方面的结果。还对实习生与顾问医生进行的短期住院甲状腺手术进行了亚组分析。
在研究期间，我院共评估了439例患有甲状腺外科疾病的患者，其中110例患者（58例病例和52例对照）符合纳入标准。发现社会经济地位较低且自费的年轻患者更倾向于短期住院甲状腺手术。两组在麻醉后出院评分（PADS）、并发症发生率和患者满意度方面无显著差异；然而，短期住院组的住院费用显著降低（p<0.001）。在亚组分析中，实习生进行的手术操作时间更长；然而，在平均PADS和并发症发生率方面无显著差异。
对于接受甲状腺手术的患者，短期住院甲状腺切除术可为传统甲状腺切除术提供更好的成本效益选择，即使在资源匮乏的环境中，内分泌外科实习生也可安全地进行该手术。
