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Lid geworden op: 11 sep 2013, 22:42
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Dagbehandeling operatie schildklier

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Lees hele artikel met link: Introduction of day care thyroid surgery in a Dutch non-academic hospital
ORIGINAL ARTICLE R.R. Dulfer, K.S. de Valk, F. Gilissen, T.M. van Ginhoven, P.C. Smit
The Netherlands Journal of Medicine

Hemithyroidectomy is the most common endocrine surgical procedure performed in daily practice and indicated mainly due to mechanical and/or cosmetic complaints of a multinodular goitre or a solitary thyroid nodule. Furthermore, it is performed for diagnostic purposes in case of indeterminate cytology. Despite the increased rate of day care surgical procedures, thyroid surgery in the Netherlands is currently solely performed with overnight stays. It is assumed that the potential risk of life-threatening respiratory problems caused by postoperative bleeding, laryngeal nerve injuries or hypocalcaemia warranting (intravenous) supplementation are reasons for which thyroid surgery is not performed in the day care setting. Recently, Segel et al.1 published their results regarding over 1000 thyroidectomies in the outpatient setting. The most feared complication, acute postoperative haemorrhage with a potentially life-threatening airway obstruction, did not occur. In general, the incidence of postoperative bleeding varies between 0.1-1.1%, and seldom causes acute airway problems or need for reinterventions.2 In addition, laryngeal nerve injury after hemithyroidectomy is uncommon and the literature reports incidence rates of up to 3.7% of patients, with 0.4% permanent injuries to the laryngeal nerve.3-7 Temporary hypocalcaemia occurred in about 3% of the outpatient patients treated in Segel’s study.1 Wound infection occurs in less than 1% of the patients, but is a late complication and poses no threat in the day care setting.4,6

Worldwide, the number of outpatient thyroidectomies has increased by 39% over the last ten years.8 Technological advancements in anaesthesia care and the widespread introduction of minimally invasive surgical techniques have fuelled this trend. The first report regarding thyroid surgery in the day care setting by Steckler dates back to 1986.9 Since then, multiple studies have shown that day care thyroid surgery is safe and feasible with regard to hemithyroidectomy and even total or completion thyroidectomy.1,2,4-7,10-13 The American Thyroid Association published a statement regarding outpatient thyroid surgery describing important safety criteria for selecting eligible patients.14

Given all the encouraging reports it is peculiar why day care thyroid surgery is not yet implemented in the Netherlands. One can only assume that the risk, albeit utterly small, of losing a patient due to respiratory distress caused by massive bleeding after discharge is the main reason. Therefore our first aim was to assess the safety of thyroid surgery in our institution by means of a retrospective risk analysis of all patients who underwent hemithyroidectomy in a five-year period from 2010 to 2014. Then we present the initial results of implementing day care thyroid surgery in our daily practice, strictly adhering to the international guidelines.14
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