Mowschenson P M, Hodin R A
Department of Surgery, Beth Israel Hospital, Boston, Mass, USA.
Surgery. 1995 Dec;118(6):1051-3; discussion 1053-4. doi: 10.1016/s0039-6060(05)80113-8.
The purpose of this study was to determine feasibility, safety, and cost savings of outpatient thyroid and parathyroid surgery.
Consecutive unselected patients undergoing thyroid and parathyroid operations by two surgeons with a special interest in endocrine surgery were studied prospectively.
One-hundred patients underwent operation, 61 as outpatients and 39 as inpatients. Outpatients included those undergoing thyroid lobectomy (39), total thyroidectomy (10), total thyroidectomy with parathyroidectomy (1), total thyroidectomy with modified neck dissection (1), and parathyroidectomy (10). Inpatients included those undergoing thyroid lobectomy (15), total thyroidectomy (8), total thyroidectomy with neck dissection (4), removal of substernal goiter (2), and parathyroidectomy (10). The average age of inpatients was slightly higher than that of outpatients (p < 0.05). Average hospital cost for outpatients was $1991 +/- $279 (range, $1594 to $2783) and for inpatients it was $2875 +/- 615 (range, $2031 to $4216), p < 0.001. Reasons for admission included extent of surgery (6), nausea (5), oversedation (4), urinary retention (2), inadequate home help (6), long travel time (2), patient preference (9), and medical reasons (5). No outpatients subsequently required admission.
Outpatient thyroid and parathyroid surgery can be feasible and safe and resulted in a 30% savings in hospital costs. After extensive operations patients continue to require admission for postanesthetic complications, social reasons, or presence of serious comorbid disease.
本研究的目的是确定门诊甲状腺和甲状旁腺手术的可行性、安全性及成本节约情况。
对两位专门从事内分泌外科手术的外科医生连续进行的未选择的甲状腺和甲状旁腺手术患者进行前瞻性研究。
100例患者接受了手术，61例为门诊手术，39例为住院手术。门诊患者包括接受甲状腺叶切除术（39例）、全甲状腺切除术（10例）、全甲状腺切除联合甲状旁腺切除术（1例）、全甲状腺切除联合改良颈部淋巴结清扫术（1例）以及甲状旁腺切除术（10例）的患者。住院患者包括接受甲状腺叶切除术（15例）、全甲状腺切除术（8例）、全甲状腺切除联合颈部淋巴结清扫术（4例）、胸骨后甲状腺肿切除术（2例）以及甲状旁腺切除术（10例）的患者。住院患者的平均年龄略高于门诊患者（p < 0.05）。门诊患者的平均住院费用为1991美元±279美元（范围为1594美元至2783美元），住院患者为2875美元±615美元（范围为2031美元至4216美元），p < 0.001。入院原因包括手术范围（6例）、恶心（5例）、镇静过度（4例）、尿潴留（2例）、家庭帮助不足（6例）、路途时间长（2例）、患者偏好（9例）以及医疗原因（5例）。没有门诊患者随后需要住院治疗。
门诊甲状腺和甲状旁腺手术可行且安全，可节省30%的住院费用。在进行广泛手术后，患者仍因麻醉后并发症以及社会或严重合并症等原因需要住院治疗。
