Short stay surgery ; the future for total near total thyroidectomy

Abstract EN

Objectivew : e propose a regimen for safe and cost-effective short-stay hospitalization following total / near-total thyroidectomy.

Patients and Methods : 127 total / near-total thyroidectomies between 2006 and 2009 were studied to test our short-stay thyroidectomy regimen.

Patients were admitted the day of operation and observed overnight.

Serum calcium values were obtained at 8, and 20 hours after operation.

23 hour discharge criteria included-stable vital signs, no wound or airway problems, up sloping serum calcium curve, and tolerance of normal diet and activity and availability of the close relative.

Results : Of 127 patients underwent total / near-total thyroidectomy, 116 (%) met 23-hour discharge criteria.

No deaths (0 %) occurred.

Overall morbidity 9 patients (7.08%) included four patients (3.14%) with transient hypocalcaemia, two patients (1.56%) with transient recurrent laryngeal nerve palsy, one patient (0.78%) with postoperative hemorrhage, one patient (0.78%) developed postoperative angina and another one (0.78%) developed Postoperative bronchospasm in asthmatic patient.

Two (1.56%) patients didn’t have the Capability of home self-care activities, or didn’t have the close relative at home to take care of them.

Conclusion : significant airway obstruction and wound hematoma rarely developed beyond the first 12 to 18 hours after total / near total thyroidectomy so the practice of 23 hrs short stay thyroid surgery is safe.

Serial serum calcium determinations used to construct a two-point calcium curve within 20 hours after operation can reliably and safely identify patients at risk to have clinically significant hypocalcaemia.