Ambulatory Thyroidectomy: A Multistate Study of Revisits and Complications. (June 2015)

• Record Type: Journal Article
• Authors: Orosco, Ryan K.; Lin, Harrison W.; Bhattacharyya, Neil
• Is Part Of: Otolaryngology--head and neck surgery. Volume 152:Number 6(2015:Jun.)
• Page Start: 1017
• Page End: 1023
• Publication Date: 2015-06
• Subjects: thyroidectomy -- thyroid surgery -- outpatient -- ambulatory surgical procedures -- surgery -- outpatient -- perioperative complications -- revisits; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599815577603
• Languages: English
• ISSNs: 0194-5998

Abstract

Objective: Determine rates and reasons for revisits after ambulatory adult thyroidectomy. Study Design: Cross-sectional analysis of multistate ambulatory surgery and hospital databases. Setting: Ambulatory surgery data from the State Ambulatory Surgery Databases of California, Florida, Iowa, and New York for calendar years 2010 and 2011. Subjects and Methods: Ambulatory thyroidectomy cases were linked to state ambulatory, emergency, and inpatient databases for revisit encounters occurring within 30 days. The numbers of revisits, mortality, and associated diagnoses were analyzed. Results: A total of 25, 634 cases of ambulatory thyroid surgery were identified: 44.2% total thyroidectomy (TT) and 55.8% partial thyroidectomy (PT). Common indications for surgery included goiter/cyst (39.5%), benign/uncertain neoplasm (24.2%), and malignant neoplasm (24.0%). The 30-day revisit rate was 7.2% (n = 1858; 61.8% emergency department, 22.4% inpatient admission, and 15.8% ambulatory surgery center). The most common diagnosis at revisit was hypocalcemia (20.8% of revisits), followed by wound hematoma/seroma/bleeding (7.1%). Higher rates of revisit, hypocalcemia, and hematoma/seroma/bleeding were seen in patients undergoing TT ( P < .016 for all). Sixteen patients had bleeding less than 24 hours after the index procedure (0.1% overall, 0.9% of revisits). Most hypocalcemia and hematoma/bleeding occurred over the first postoperative week. Three deaths occurred within 30 days of the index procedure. Conclusion: In carefully selected patients, ambulatory thyroidectomy demonstrates a good postoperative morbidity and mortality profile. Common reasons for revisits included hypocalcemia and bleeding/seroma/hematoma, which occurred with relatively high frequencies as late as a week after surgery. Quality improvement measures should be targeted at lowering revisit rates and safely managing complications.