Rosen Philip, Bailey Luke, Manickavel Sudhir, Gentile Christopher, Grayson Jessica, Buczek Erin
Department of Otolaryngology Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
OTO Open. 2021 Mar 10;5(1):2473974X21995104. doi: 10.1177/2473974X21995104. eCollection 2021 Jan-Mar.
To compare financial impact between patients undergoing ambulatory (same-day discharge) vs overnight admission after total thyroidectomy while showing associated surgical outcomes.
Retrospective review.
University of Alabama at Birmingham Medical Center from October 2011 and July 2017.
Patients undergoing total thyroidectomy without concurrent procedures were selected for review. Demographics, comorbidities, admission status, postoperative outcomes including minor and major complications, charges, and costs were collected. Admission status was categorized as inpatient (admission to hospital ≥1 night) or outpatient (discharged from the postoperative recovery unit). Costs were obtained from all related hospital, clinic, and emergency department visits at the University of Alabama at Birmingham within 30 days of the original surgery. After statistical analysis, outcomes and costs were compared between inpatient and outpatient total thyroidectomy patients.
Of 870 total thyroidectomy patients included for analysis, 367 (42.2%) met outpatient criteria. A total of 169 patients (19.4%) had a complication, and only hypocalcemia occurred significantly more in the inpatient group (14.3% vs 9.26%; < .05). No complications occurred more frequently in the outpatient population. There were no mortalities. There was a statistically significant difference between the total cost of inpatient and outpatient thyroidectomies, with outpatient surgery costing on average $2367.27 less per patient ( < .0001).
Outpatient total thyroidectomy can lead to cost reduction in highly selected patients who have few comorbidities while remaining safe for the patient.
比较甲状腺全切除术后门诊（当日出院）与过夜住院患者的经济影响，并展示相关手术结果。
回顾性研究。
2011年10月至2017年7月期间的阿拉巴马大学伯明翰医学中心。
选取接受甲状腺全切除术且未同时进行其他手术的患者进行回顾性研究。收集患者的人口统计学资料、合并症、住院状态、术后结果（包括轻微和严重并发症）、费用及成本。住院状态分为住院患者（住院≥1晚）或门诊患者（从术后恢复单元出院）。成本数据来自阿拉巴马大学伯明翰分校所有相关医院、诊所及急诊科在初次手术后30天内的就诊记录。经统计分析后，比较住院和门诊甲状腺全切除术患者的手术结果及成本。
纳入分析的870例甲状腺全切除术患者中，367例（42.2%）符合门诊标准。共有169例患者（19.4%）出现并发症，仅低钙血症在住院患者组中显著更常见（14.3%对9.26%；P<0.05）。门诊患者中未出现更频繁的并发症。无死亡病例。住院和门诊甲状腺全切除术的总成本存在统计学显著差异，门诊手术平均每位患者花费少2367.27美元（P<0.0001）。
对于合并症少的高度选择患者，门诊甲状腺全切除术可降低成本，且对患者而言仍安全。
