Thyroid Ablation in Operating Rooms Result in Fewer Side Effects Than Ambulatory Settings

Roberto Novizio, MBBS

A new study from investigators in Europe is underlining the potential increase in risk for side effects observed with thyroid radiofrequency ablation performed in ambulatory settings compared to those performed in an operating room setting.

Presented at the Annual Meeting of the American Thyroid Association (ATA), suggests performing radiofrequency ablation in an operating room setting was associated with less intraoperative pain, intra-nodular bleeding, and postoperative swelling compared to radiofrequency ablations performed in ambulatory settings.

“As the side effects drop remarkably with general anesthesia in the operating room, as anesthesiologists, we recommend radiofrequency be carried out in the operating room setting,” said Roberto Novizio, MBBS, resident physician at the Endocrine and Thyroid Clinic in Reggio Emilia, Italy, during his presentation.

Novizio and a team of colleagues designed the current study to fill the apparent knowledge gap related to the potential for side effects in ambulatory versus operating room setting. To do so, investigators designed their study as an analysis of patients undergoing ultrasound-assisted radiofrequency ablation in ambulatory settings under local anesthesia or an operating room setting with general anesthesia. Using patient data from the Endocrine and Thyroid Clinic, investigators identified a group of 40 patients who underwent radiofrequency ablation in an ambulatory setting and 314 who underwent radiofrequency ablation.

Of note, those who underwent radiofrequency ablation in an ambulatory setting receiving local pericapsular anesthesia with lidocaine plus ropivacaine and general sedation using IV midazolam. In addition to local anesthesia and with anesthesiologic assistance, those in the operating room setting received oxygen supplementation through nasal cannula, IV fentanyl, and midazolam and propel through a cannulated vein.

For the purpose of analysis, investigators hoped to compare side effects stratified into 3 time periods: intraoperative, immediate postoperative, and periprocedural. Outcomes of interest during the intraoperative period included intense pain, intra-nodular and pericapsular bleeding, vasovagal reaction, and cough. Outcomes of interest during the immediate postoperative period included swelling, cutaneous burn, and laryngeal dysfunction. Outcomes of interest during the periprocedural period, which was defined as within 30 days of the procedure, were bruise, fever, pseudo-cystic transformation, and nodule rupture.

Upon analysis, results indicated the presence of a statistically significant reduction of side effects for the operating room group compared to the ambulatory setting groups in all analyses (P <.05). For the intraoperative period, patients in the ambulatory group were more likely to experience intense pain (17.5% vs 0%), intra-nodular bleeding (7.5% vs 0.64%), peri-capsular bleeding (2.5% vs 0.33%), vasovagal reaction (2.5% vs 0%), and cough (5% vs 1.59%). For the postoperative period, patients in the ambulatory group were more likely to experience swelling 10% vs 0.95%, cutaneous burn 5% vs 0.33%, laryngeal dysfunction 5% vs 0.33%. For the peri-procedural period, those in the ambulatory group were more likely to experience bruising (5% vs 1.59%), fever (2.5% vs 0%), pseudo-cystic transformation (2.5% vs 0%), and nodule rupture (2.5% vs 0%).

In his conclusion, Novizio pointed out the operating room costs need to be considered but the reduction in side effects leads them to recommending radiofrequency ablation be carried out using the operating room setting when possible.

This study, “Side effects rates comparison in thyroid radiofrequency ablation between ambulatory setting and operating room setting,” was presented at ATA 2021.