Outpatient Thyroidectomy: Pros, Cons, and Precautions

What are the current issues and concerns with outpatient thyroidectomy? That’s the topic JAMA Otolaryngology—Head & Neck Surgery examined in the October 2014 issue with clinical reviews and invited commentary from subject experts.

In the journal’s Clinical Review and Education section, David L .Steward, MD, from the University of Cincinnati’s (Ohio) Department of Otolaryngology—Head and Neck Surgery, discussed thyroidectomy’s transformation from an inpatient procedure in the 1970s to a procedure increasingly performed in outpatient settings. He reported that up to 65% of all thyroidectomies are now done as outpatient procedures, and high-volume surgeons have very low complication rate with these surgeries. Among the benefits he identified are cost, patient satisfaction, and a good safety record. Concerns included management of potential post-operative complications (especially late hemorrhage and hematoma with potential airway compromise), and a variety of other adverse events.

In invited commentary, Ralph P. Tufano, MD, MBA, stressed that the main criteria for moving any surgery to outpatient clinics is patient safety and quality of care. In addition to the benefits Dr. Steward noted, he added decreased risk of nosocomial infections and less opportunity for medical errors and/or iatrogenic complications. He acknowledged the risks described above. He proposed, at a minimum, overnight observation in a medical facility.

The authors converged in their recommendations. Both are advocates for standardized care, safety, and quality. They both stressed that in this and any outpatient surgery, patients need to be thoroughly screened and well educated. In addition, surgeons who perform outpatient thyroidectomies need to monitor and ensure that their outcomes are comparable to those achieved with inpatient procedures.