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Ambulatory thyroidectomy: a multistate study of revisits and complications.
Published Web Locationhttps://doi.org/10.1177/0194599815577603
ObjectiveDetermine rates and reasons for revisits after ambulatory adult thyroidectomy.
Study designCross-sectional analysis of multistate ambulatory surgery and hospital databases.
SettingAmbulatory surgery data from the State Ambulatory Surgery Databases of California, Florida, Iowa, and New York for calendar years 2010 and 2011.
Subjects and methodsAmbulatory 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.
ResultsA 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.
ConclusionIn 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.
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