Annesi Chandler A, Gillis Andrea, Fazendin Jessica M, Lindeman Brenessa, Chen Herbert
Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
World J Surg. 2024 Dec;48(12):2899-2906. doi: 10.1002/wjs.12319. Epub 2024 Aug 22.
There has been a shift in recent years toward same-day parathyroidectomies due to the decrease in mutual costs with few significant differences in postoperative morbidity or mortality. We sought to determine if demographics, preoperative patient risk factors, or comorbidities were associated with a patient's likelihood of having same-day or inpatient surgery.
A prospective database of parathyroid operations from 2001 to 2022 (n = 2948 patients) was reviewed for surgeries completed for primary hyperparathyroidism. Patients were categorized as same-day or inpatient surgery; demographics, risk factors, and co-morbidities were examined and differences across practice patterns during the 21-year period were studied and also analyzed in a subset of patients from 2013 to 2022.
In a recent subset of patients from 2013 to 2022, patients having inpatient surgery were more likely to be Black and use anticoagulation or antiplatelet therapy. Multivariable regression confirmed increased odds of aging and black patients requiring inpatient parathyroidectomy. Compared to 2001-2003, there was a significantly increased proportion of patients undergoing same-day surgery; compared to 2010-2012, there was a similar proportion of patients undergoing outpatient surgery between 2013 and 2018, and there was an increased proportion from 2019 through 2022.
Same-day parathyroidectomies have been shown to be safe and has become the typical practice for high-volume parathyroid surgeons over the last decade. Complications such as postoperative hematoma or hypocalcemia were previously shown to be incompletely mitigated by increased LOS or inpatient surgery, although demographics are considered to increase the odds of inpatient parathyroidectomy.
近年来，由于相互成本的降低，甲状旁腺切除术已转向当日手术，术后发病率或死亡率几乎没有显著差异。我们试图确定人口统计学、术前患者风险因素或合并症是否与患者进行当日或住院手术的可能性相关。
回顾了2001年至2022年甲状旁腺手术的前瞻性数据库（n = 2948例患者），以了解因原发性甲状旁腺功能亢进而完成的手术情况。患者被分为当日手术或住院手术；检查了人口统计学、风险因素和合并症，并研究了21年期间不同手术模式的差异，还对2013年至2022年的一部分患者进行了分析。
在2013年至2022年的最近一部分患者中，接受住院手术的患者更有可能是黑人，并且使用抗凝或抗血小板治疗。多变量回归证实，年龄较大和黑人患者需要住院进行甲状旁腺切除术的几率增加。与2001 - 2003年相比，接受当日手术的患者比例显著增加；与2010 - 2012年相比，2013年至2018年门诊手术患者的比例相似，而2019年至2022年比例有所增加。
当日甲状旁腺切除术已被证明是安全的，并且在过去十年中已成为大量进行甲状旁腺手术的外科医生的典型做法。尽管人口统计学因素被认为会增加住院甲状旁腺切除术的几率，但先前研究表明，术后血肿或低钙血症等并发症并不会因住院时间延长或住院手术而得到完全缓解。
