Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1001 Main Street, Buffalo, NY, 14203, USA.
Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, USA.
Pediatr Surg Int. 2021 Sep;37(9):1259-1264. doi: 10.1007/s00383-021-04927-w. Epub 2021 May 20.
Studies have demonstrated that same-day discharge (SDD) following thyroid resection is safe and feasible in adults but there are no similar studies in the pediatric age group. The purpose of this study is to evaluate the influence of SDD on 30-day readmission rates following thyroid surgery in pediatric patients.
This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program-Pediatric database to evaluate 30-day readmission rates among patients < 19 years of age who underwent thyroid resection between 2012 and 2017. Patients excluded were those discharged more than 2 days after surgery. The main exposure variable was SDD and the primary outcome was 30-day readmission. Secondary outcomes included wound complications, unplanned reoperation and death. Patient characteristics were compared using chi-squared testing and odds ratios for readmission were calculated using multivariate logistic regression.
Of the 1125 patients (79% female, median age 15 years), 122 (11%) were discharged on the day of surgery. Total or near-total thyroidectomy represented the majority of operations (714, 63.5%) and patients undergoing these operations were less likely to be discharged on the same day as surgery compared to those undergoing thyroid lobectomy (4.3 vs. 22.1%, P < 0.001). Twenty-nine patients were readmitted within 30 days (3 in the same day group, 26 in the later group). There was no difference in the odds of readmission between the two groups (adjusted odds ratio in SDD compared to later discharge 1.04 [95% CI 0.29-3.75, P = 0.96; readmission rate, 2.46 vs. 2.59%). Wound complications were reported in two patients, both in the later discharge group.
Same-day discharge in pediatric patients undergoing thyroidectomy is not associated with an increase in 30-day readmissions or wound complications when compared to patients discharged 1 or 2 days after surgery. In selected patients, SDD may be an appropriate alternative to traditional overnight stay.
研究表明，成人甲状腺切除术后当天出院（SDD）是安全且可行的，但在儿科人群中尚无类似研究。本研究旨在评估 SDD 对儿童甲状腺手术后 30 天再入院率的影响。
本回顾性队列研究使用美国外科医师学院国家外科质量改进计划-儿科数据库，评估 2012 年至 2017 年间行甲状腺切除术的年龄<19 岁患者的 30 天再入院率。排除术后 2 天以上出院的患者。主要暴露变量为 SDD，主要结局为 30 天再入院。次要结局包括伤口并发症、计划外再次手术和死亡。使用卡方检验比较患者特征，使用多变量逻辑回归计算再入院的比值比。
在 1125 例患者（79%为女性，中位年龄 15 岁）中，122 例（11%）在手术当天出院。甲状腺全切除术或近全切除术占大多数手术（714 例，63.5%），与行甲状腺叶切除术的患者相比，行这些手术的患者更不可能在手术当天出院（4.3% vs. 22.1%，P<0.001）。30 天内有 29 例患者再入院（同日组 3 例，延迟组 26 例）。两组间再入院的几率无差异（SDD 组与延迟出院组比较的校正比值比 1.04[95%CI 0.29-3.75，P=0.96；再入院率 2.46% vs. 2.59%]）。两组均有 2 例患者发生伤口并发症，均在延迟出院组。
与术后 1 或 2 天出院的患者相比，儿童甲状腺切除术患者当天出院与 30 天再入院或伤口并发症增加无关。在选择合适的患者中，SDD 可能是传统过夜住院的替代方案。
