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Outpatient Thyroidectomy

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on 17 April 2010

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Transcript of Outpatient Thyroidectomy

Outpatient Thyroidectomy Methods
Retrospective/Prospective review of all (1242) thyroidectomies by SKS from 2003-2009

success of planned outpatient vs inpatient
ASA class
time to discharge
ER visits/admissions

1242 Thyroidectomies
1136 Planned as Outpatient
=1064 Completed as Outpatient 106 Planned as Inpatient - 73 converted inpatient + 1 inpatient--> outpatient + 73 converted--> inpatient - 1 converted--> outpatient =178 Completed as Inpatient Background
traditionally inpatient procedure
1990's --> 23 hour observation
recent progression to selective same day discharge excellent patient satisfaction and tolerance safe, cost-effective Hematoma Outpatient
(N=1064) Inpatient
(N=105) Converted to Inpt.
(N=73) 2 (0.19%) 2 (2.7%) 1 (0.95%) Hematoma
Overall 0.4% incidence
No bedside decompression
All operative evacuation Hematoma Timing Outpatient (2) Converted to Inpt (2) Inpatient (1) 2 days, smoker, coughing
18hrs, transient RLN injury, coughing 2 hrs, continued ASA use
12 hrs, transient RLN injury, coughing 4 hrs, cirrhosis, coughing Recurrent Laryngeal Nerve Injury Outpatient
(N=1064) Converted to Inpt.
(N=73) Inpatient
(N=105) Transient Permanent 39 (3.7%) 4 (0.38%) 12 (16.4%) 0 3 (2.9%) 2 (1.9%) 30 Day Mortality (0.3%) Outpatient (1)
POD #2, nursing home, presumed cardiac event Inpatient (3)
POD #6, pulm HTN, R heart failure
POD #8, tracheal stenosis, respiratory arrest
POD #9, thyroid storm, heart failure, metastatic follicular cancer Discussion
Decision: who and when to discharge
outpatient incidence: 0.19%
only 1 within 24 hrs (0.09%)
should all RLN injuries be observed?
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