Traill Lauren, Kendall Mark C, Caramez Maria Paula, Apruzzese Patricia, De Oliveira Gildasio
Department of Anesthesiology, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA.
Department of Anesthesiology, Rhode Island Hospital, Providence, RI, 02903, USA.
Perioper Med (Lond). 2023 Aug 8;12(1):45. doi: 10.1186/s13741-023-00335-x.
To address the postoperative outcomes between outpatient and inpatient neck surgery involving thyroidectomy procedures.
A cohort analysis of surgical patients undergoing primary, elective, total thyroidectomy from multiple United States medical institutions who were registered with the American College of Surgeons National Surgical Quality Improvement Program from 2015 to 2018. The primary outcome was a composite score that included any 30-day postoperative adverse event.
A total of 55,381 patients who underwent a total thyroidectomy were identified comprising of 14,055 inpatient and 41,326 outpatient procedures. A cohort of 13,496 patients who underwent outpatient surgery were propensity matched for covariates with corresponding number of patients who underwent inpatient thyroidectomies. In the propensity matched cohort, the occurrence of any 30-day after surgery complications were greater in the inpatient group, 424 out of 13,496 (3.1%) compared to the outpatient group, 150 out of 13,496 (1.1%), P < 0.001. Moreover, death rates were greater in the inpatient group, 22 out 13,496 (0.16%) compared to the outpatient group, 2 out of 13,496 (0.01%), P < 0.001. Similarly, hospital readmissions occurred with greater frequency in the inpatient group, 438 out of 13,496 (3.2%) compared to the outpatient group, 310 out of 13,496 (2.3%), P < 0.001.
Thyroidectomy procedures performed in the outpatient setting had less rates of adverse events, including serious postoperative complications (e.g., surgical site infection, pneumonia, progressive renal insufficiency). In addition, patients who had thyroidectomy in the outpatient setting had less 30-day readmissions and mortality. Surgeons should recognize the benefits of outpatient thyroidectomy when selecting disposition of patients undergoing neck surgery.
探讨甲状腺切除手术中门诊手术与住院手术的术后结局。
对2015年至2018年在美国多个医疗机构接受初次择期全甲状腺切除术且登记于美国外科医师学会国家外科质量改进计划的手术患者进行队列分析。主要结局是一个综合评分，包括任何术后30天不良事件。
共识别出55381例接受全甲状腺切除术的患者，其中14055例为住院手术，41326例为门诊手术。对13496例行门诊手术的患者队列与相应数量的行住院甲状腺切除术的患者进行协变量倾向匹配。在倾向匹配队列中，住院组术后30天内任何并发症的发生率更高，13496例中有424例（3.1%），而门诊组为13496例中有150例（1.1%），P＜0.001。此外，住院组的死亡率更高，13496例中有22例（0.16%），而门诊组为13496例中有2例（0.01%），P＜0.001。同样，住院组再次入院的频率更高，13496例中有438例（3.2%），而门诊组为13496例中有310例（2.3%），P＜0.001。
门诊环境下进行的甲状腺切除手术不良事件发生率较低，包括严重术后并发症（如手术部位感染、肺炎、进行性肾功能不全）。此外，门诊甲状腺切除手术患者的30天再入院率和死亡率更低。外科医生在选择颈部手术患者的处置方式时应认识到门诊甲状腺切除术的益处。
