Questionable safety of thyroid surgery with same day discharge.
Questionable safety of thyroid surgery with same day discharge.
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DOI：
10.1308/003588412x13373405384576
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发表时间：
2012-11
影响因子：
1.4
通讯作者：
British Association of Endocrine and Thyroid Surgeons
中科院分区：
文献类型：
--
作者：
Doran HE;England J;Palazzo F;British Association of Endocrine and Thyroid Surgeons
在过去的二十年里，越来越多的外科手术是在门诊病人的基础上进行的。2000年，英国国家卫生服务局设定了将75%或更多的择期外科手术作为日间手术的目标，2001年，英国日间手术协会将甲状腺切除术添加到日间手术列表中。然而，只有极少数英国中心采用甲状腺切除术后当天出院。本综述的目的是建立关于当天出院甲状腺手术的证据基础。英国内分泌和甲状腺外科医生协会委托作者对关于日间甲状腺手术的最佳可用证据进行审查，作为该组织将采用的共识立场的一部分。对英文医学文献进行了MEDLINE®综述，并对相关文章进行了整理和综述。关于日间甲状腺手术的比较数据有限。这是可行的，并可能节省个别医院的住院费用。然而，气道损害和危及生命的术后出血的风险仍然是一个主要问题，因为它是不可能的，以积极确定那些患者在甲状腺切除术后出血的风险最大和最小。据估计，如果患者在手术后6小时出院，则所有甲状腺切除术后出血的一半将发生在医院环境之外。在英国，同一天出院不能被认可。任何经济利益都可能被患者暴露于增加的不良结局风险所超过。因此，建议23小时手术。
Over the last two decades increasing numbers of surgical procedures have been performed on an outpatient basis. In 2000 the National Health Service in England set the target of performing 75% or more of all elective surgical procedures as day cases and in 2001 the British Association of Day Surgery added thyroidectomy to the list of day case procedures. However, same day discharge following thyroidectomies has been adopted by only a very small number of UK centres. The aim of this review was to establish the evidence base surrounding same day discharge thyroid surgery. The British Association of Endocrine and Thyroid Surgeons commissioned the authors to perform a review of the best available evidence regarding day case thyroid surgery as a part of a consensus position to be adopted by the organisation. A MEDLINE® review of the English medical literature was performed and the relevant articles were collated and reviewed. There are limited comparative data on day case thyroid surgery. It is feasible and may save individual hospitals the cost of inpatient stay. However, the risk of airway compromising and life threatening post-operative bleeding remains a major concern since it is not possible to positively identify those patients most and least at risk of bleeding after thyroidectomy. It is estimated that half of all post-thyroidectomy bleeds would occur outside of the hospital environment if patients were discharged six hours after surgery. Same day discharge in a UK setting cannot be endorsed. Any financial benefits may be outweighed by the exposure of patients to an increased risk of an adverse outcome. Consequently, 23-hour surgery is recommended.