FEASIBILITY OF FAST TRACK THYROID SURGERY

Abstract

Background: In recent years, the duration of hospital stay after surgical procedures has decreased significantly. Traditionally thyroid surgery has been done on an inpatient basis with an observation period of 48-72hours. With the advent of minimally invasive techniques, improved anaesthesia, pain control, changing attitude of patients to recovery alongwith increasing patient load, low financial resources and long surgical waiting lists, the concept of short hospital stay has come into limelight. Recent studies have suggested the safety and cost effectiveness however, there are some potential risks associated with fast track thyroid surgery.

Objective: The objective of our study was to determine the feasibility of fast track thyroid surgery in our setting and at the same time to seek the patient and operation parameters that could make the surgery safe.

Study design: Prospective study.

Participants: 74 patients in the age group of 15-65 years.

Methods: From August 2017 to July 2019, 74 patients underwent fast track thyroid surgery after being meticulously assessed according to the selection criteria. Patients were optimized on the outpatient basis and admitted a day before operation. Patients were subjected to various thyroid procedures based upon the pathology and were discharged the day after. A prospective study was performed for them, the clinico-pathological aspects of the disease and the outcome of the thyroid surgery were assessed regarding hospital stay, the time when the drains were removed, postoperative complications, interventions and readmissions.

Results: 74 patients were operated with the mean age of 34.7±11.4 of which 61 were females and 13 males. All patients were hospitalized less than 24 hours with the mean hospital stay of 20.9 hrs. Hypocalcaemia was the most common complication observed in 4.1%, temporary dysphonia in 2.7%, hematoma and seroma in 1.4% cases.3 patients (4.1%) were readmitted for transient hypocalcaemia.

Conclusions: Hypocalcaemia is a well-known barrier to fast track thyroidectomy. With increased surgeon experience and improved patient education, selection and care this approach can be considered truly safe.