day surgery for thyroid: initial experience evaluation

BACKGROUND. Modern medicine is going toward short-stay treatment models. We have recently opened a “day-surgery” unit including thyroid sessions . We planned to verify our results after 2 months of activity in order to assess the adequacy of patient selection criteria and management protocols. This study reports the early results of our experience. METHODS. From October to December 2001 we proposed day-surgery treatment to thyroid patients fitting general admission criteria (clinical, logistical, social). Non differentiated or locally advanced tumours, big or intrathoracic goiters and recurrent disease were excluded. Preoperative work-up was made on an outpatient basis: surgical and anaesthetic evaluation and preoperative examinations. Patients were admitted the morning of the operation and discharged 24 hours later. If discharge criteria were not met, they were transferred in the near surgical ward. Postoperative hypocalcemia was treated according to a standard protocol. Further calcium determinations were prescribed as needed; a dedicated phone line was available 24 hrs a day for any urgent communication. RESULTS. In this period we performed 74 thyroid operations (59 female, mean age 41.3, s.d. 11.9, range 14-69 yrs). Preoperative diagnosis was single nodule (n=34), multinodular goiter (n=24) and differentiated thyroid cancer (n=16, including 5 completion lobectomies). We performed 39 thyroidectomies (33 open, 6 video), 34 lobectomies (26 open, 8 video) and 1 isthmusectomy. Among the 45 patients with no thyroid remnant, mean postoperative calcium on the day of surgery was 9.1 mg/dl (s.d. 0.5), and on first p.o. day was 8.5 mg/dl (s.d. 0.6). 4 patients experienced symptomatic hypocalcemia. Only one patient was transferred in the surgical ward due to pharyngeal pain and hypocalcemia. 7 subjects had asymptomatic hypocalcemia and were managed as outpatients. At follow-up all of them were highly satisfied of the treatment received. CONCLUSIONS. A day surgery Unit can work safely and efficiently provided a careful selection of candidates and a solid organization. A significant number of thyroid patients are potential candidates for day surgery treatment, allowing relevant financial savings for the Health System. Our protocol permitted an effective and safe management of postoperative complications. The initial evaluation of our results was satisfying and encouraged us to further develop thyroid surgery in a day surgery environment