Department of Otolaryngology, Head and Neck Surgery, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
Eur Arch Otorhinolaryngol. 2020 Sep;277(9):2527-2531. doi: 10.1007/s00405-020-05921-z. Epub 2020 Apr 3.
Day-case thyroid surgery has been endorsed by the American Thyroid Association and the British Association of Day Surgery. Despite the many benefits of day surgery, day-case thyroid surgery is not widely practiced. We describe the use of sensitivity analysis modelling and cost analysis in determining and refining the patient cohort that safely meet the threshold for a new day-case thyroid lobectomy service at a tertiary referral head and neck centre.
All cases of first-time thyroid lobectomy were identified between 2015 and Q2 2019. Patients suitable for day-case thyroid lobectomy were identified retrospectively, according to the following criteria: Age < 65 years, ASA grade < 3, BMI < 30 kg/m and distance from tertiary unit < / = 30 min. Sensitivity analysis was undertaken, manipulating each parameter in turn to assess the effect on eligibility and associated cost-savings.
259 Thyroid lobectomy procedures were performed, 173 of these met inclusion criteria. Sensitivity analysis revealed that after increasing all day-case parameters by four increments, eligibility increased from 47 (27%) to 112 patients (64.7%), with only one outpatient to inpatient conversion. Multivariate logistical regression analysis found that age was the only variable to increase the risk of adverse outcomes (OR = 1.10, p < 0.05). Using data from the NHS reference costs, if 60% of all thyroid lobectomies nationally were undertaken as day-case, this would have amounted to savings of £26.3 m over five years.
Through sensitivity analysis, we determined that we could safely offer day-case thyroid lobectomy to 64.7% of our patient cohort.
美国甲状腺协会和英国日间手术协会已经认可了日间甲状腺手术。尽管日间手术有许多好处，但日间甲状腺手术并未得到广泛应用。我们描述了使用敏感性分析模型和成本分析来确定和完善符合新的日间甲状腺叶切除术服务阈值的患者群体，该服务在一家三级转诊头颈中心。
在 2015 年至 2019 年第二季度期间，确定了所有初次甲状腺叶切除术的病例。根据以下标准，回顾性确定适合日间甲状腺叶切除术的患者：年龄<65 岁，ASA 分级<3，BMI<30kg/m 2 ，且距离三级单位<30 分钟。进行了敏感性分析，依次操纵每个参数，以评估对合格性和相关成本节约的影响。
共进行了 259 例甲状腺叶切除术，其中 173 例符合纳入标准。敏感性分析显示，将所有日间手术参数增加四个增量后，合格性从 47 例（27%）增加到 112 例（64.7%），仅发生了 1 例门诊转住院。多变量逻辑回归分析发现，年龄是唯一增加不良结果风险的变量（OR=1.10，p<0.05）。使用 NHS 参考成本数据，如果全国 60%的甲状腺叶切除术都作为日间手术进行，那么在五年内将节省 2630 万英镑。
通过敏感性分析，我们确定可以安全地为 64.7%的患者群体提供日间甲状腺叶切除术。
