Ambulatory thyroid surgery: do the risks overcome the benefits?
With appropriate selection, ambulatory thyroid surgery is feasible. Thyroid surgery is unique amongst ambulatory procedures in that it is associated with a small but unpredictable risk of rapid onset compromising cervical haematoma that may require immediate treatment. Reports of "safety" are frequently from series which are too small to give complete assurance. Postoperative haemorrhage is the only issue that makes day case surgery questionable because other risks (hypocalcaemia, nerve injury) can be mitigated. Studies suggest 20-60% bleed will occur after 6 hours but the clinical severity of later bleeds is unclear. The reliability of more specific data from complications occurring at home is liable to under-reporting. The need for a tracheostomy is considerably higher when there is a delay in the recognition of symptoms (as it could be at home) and re-intervention; this underlies the increased morbidity with laryngeal and supraglottic oedema that may accompany a delay in the treatment of post-thyroidectomy bleeds. The estimated cost savings from ambulatory thyroid surgery may be an over-estimate given that true costs may be reduced by optimisation of ward staffing.
Salford Royal Foundation Trust, department surgery, Stott Lane, M6 8HD, Salford, United Kingdom. Electronic address: helen.doran@srft.nhs.uk.
Helen E
HE
Doran
Hammersmith hospital, department endocrine and thyroid surgery, Imperial college, W12 0HS, London, United Kingdom.
Fausto
F
Palazzo
D000556:Ambulatory Surgical Procedures / Q000379:methods*; D006801:Humans; D011183:Postoperative Complications; D018570:Risk Assessment; D013961:Thyroid Gland / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*