Thyroidectomy using monitored local or conventional general anesthesia: an analysis of outpatient surgery, outcome and cost in 1,194 consecutive cases.
BACKGROUND
Critical appraisal of safety, feasibility, and economic impact of thyroidectomy procedures using local (LA) or general anesthesia (GA) is performed.


METHODS
Consecutive patients undergoing thyroidectomy procedures were selected from a prospective database from January 1996 to June 2003 of a single-surgeon practice at a tertiary center. Statistical analyses determined differences in patient characteristics, outcomes, operative data, and length of stay (LOS) between groups. A cohort of consecutive patients treated in 2002-2003 by all endocrine surgeons at the institution was selected for cost analysis.


RESULTS
A total of 1,194 patients underwent thyroidectomy, the majority using LA (n = 939) and outpatient surgery (65%). Female gender (76%), body mass index > or = 30 kg/m2 (29%), median age (49 years), and cancer diagnosis (45%) were similar between groups. Extent of thyroidectomy (59% total) and concomitant parathyroidectomy (13%) were similarly performed. GA was more commonly utilized for patients with comorbidity [15% vs. 10%, Anesthesia Society of America (ASA) > or = 3; P < 0.001], symptomatic goiter (13% vs. 7%; P = 0.004), reoperative cases (10% vs. 6%; P = 0.01), and concomitant lymphadenectomy procedures (15% vs. 3%; P < 0.001). GA was associated with significant increase in LOS > or = 24 hours (17 % vs. 4%) or overnight observation (49 % vs. 14%), P < 0.001. Operative room utilization was significantly associated with type of anesthesia (180 min vs. 120 min, GA vs. LA, P < .001) and impacted to a lesser degree by surgeon operative time (89 minutes vs. 76 minutes, GA vs. LA; P = .089). Overall morbidity rates were similar between groups (GA 5.8 % vs. LA 3.2%). The actual total cost (ATC) per case for GA was 48% higher than for LA and 30% higher than the ATC for all procedures (P = 0.006), with the combined weighted average impacted by more LA cases (n = 217 vs. 85).


CONCLUSIONS
These data from a large, unselected group of thyroidectomy patients suggest LA results in similar outcomes and morbidity rates to GA. It is likely that associated LA costs are lower.
Spanknebel
Kathryn
K
Division of General Surgery, The New York Thyroid Center, College of Physicians and Surgeons, Columbia University, 177 Fort Washington Avenue, MHB-7SK, New York, NY 10032, USA. ks2166@columbia.edu
Chabot
John A
JA
DiGiorgi
Mary
M
Cheung
Kenneth
K
Curty
James
J
Allendorf
John
J
LoGerfo
Paul
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D000768:Anesthesia, General; D000772:Anesthesia, Local / Q000191:economics; D002648:Child; D005260:Female; D006801:Humans; D061224:Laryngeal Nerve Injuries; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D018579:Patient Selection; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy / Q000191:economics; D020196:Trauma, Nervous System / Q000517:prevention & control; D016896:Treatment Outcome