Short Stay Surgery; The Future For Total /Near Total Thyroidectomy

Abstract

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.