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Preoperative Evaluation/Patient Issues/Outpatient Thyroid Surgery

QUESTION:

I am an anesthesiologist in New Orleans at an outpatient center. A surgeon in the group where I work is starting to do thyroid surgery there. This includes both subtotal and total thyroidectomies where the patient goes home the same day (not a 23 hr. stay). What are your views on outpatient thyroid surgery?

-- From D.M., New Orleans, LA

REPLY:

I can't let pass this chance to give you my opinion about this topic. The most important risk of this surgical procedure is that it takes place in a tissue too close to the upper airway. There is an unavoidable risk of postsurgical edema, and moreover, the high risk of postsurgical hemorrhage is always present. In my modest opinion, these problems are seen in approximately 2% - 3% of cases, but when they occur, they place the patient at high risk because both can result in serious respiratory problems and lead to death. For all of above, I consider that this surgical procedure shouldn't be included in a same day surgery program.

-- From Enrique Conde Gareca, M.D., Santa Cruz de la Sierra, Bolivia

REPLY:

This is an interesting issue. Two head and neck surgeons at the institution where I work had differing opinions on whether partial thyroidectomy could be done as an outpatient. One saw no problem with the procedure, the other was concerned about the late development of a hematoma with the potential for airway compromise. The latter surgeon had had a recent case of need for urgent neck exploration in a postoperative partial thyroidectomy.

Both surgeons were adamant that total thyroidectomy patients should not be discharged home because of the very real risk of postoperative life-threatening hypocalcemia due to inadvertent parathyroidectomy at the time of the procedure.

Overall this would suggest that same day surgery on the thyroid is potentially risky and will eventually lead to out-of-hospital loss of airway and maybe life. I would encourage your surgeon to seek the opinions of his colleagues at other centers.

-- From P. H. N., Houston, TX

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