title: Type I thyroplasty: risk stratification approach to inpatient versus outpatient postoperative management.
abstract: BACKGROUND
  type I thyroplasty is an effective and safe procedure for unilateral vocal fold paralysis and is shifting toward outpatient postoperative care. However, serious airway complications have been reported.
  
  
  OBJECTIVE
  the aims of this study were to investigate whether risk stratification into inpatient/outpatient postoperative care reduces outpatient airway complications and to compare the cost-effectiveness and surgical outcomes of risk stratification to a historical inpatient control group (non-risk stratified).
  
  
  METHODS
  tertiary, university-based medical centre.
  
  
  RESULTS
  Three retrospective groups were examined: historical inpatient control (n = 15), risk-stratified (RS)- inpatient (n = 16), and RS outpatient (n = 17). Laryngeal edema was encountered in two historical controls (13.3%), two RS inpatients (12.5%), and one RS outpatient (5.9%). One case of implant extrusion occurred in the RS outpatient group. There was no difference in maximum phonation time or voice-related quality of life between RS versus historical controls (p > .5). The cost savings of risk stratification versus entirely inpatient care was $CAD 633.12/patient. The average duration in hospital for RS inpatient versus RS outpatient was 29.8 and 8.3 hours, respectively.
  
  
  CONCLUSIONS
  postoperative RS may reduce potentially serious outpatient airway complications and cost while improving patient satisfaction.
authors.affiliation: Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON.
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhao
authors.forename: Kathryn
authors.initials: K
authors.lastname: Roth
authors.forename: Kevin
authors.initials: K
authors.lastname: Fung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D003362:Cost-Benefit Analysis; D005260:Female; D006760:Hospitalization; D006801:Humans; D058753:Laryngoplasty / Q000191:economics; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000601:surgery*