viernes, 28 de abril de 2017

Tiroidectomía ambulatoria / Outpatient thyroidectomy

Abril 28, 2017. No. 2673


Tiroidectomía ambulatoria. ¿Es segura?
Outpatient Thyroidectomy: Is it Safe?
Surg Oncol Clin N Am. 2016 Jan;25(1):61-75. doi: 10.1016/j.soc.2015.08.003. Epub 2015 Oct 31.
Outpatient thyroid surgery is controversial because of concerns over life-threatening cervical hematoma. Despite this concern, outpatient thyroidectomy is becoming increasingly common, especially among high-volume endocrine surgeons. Multiple studies have now demonstrated that careful patient selection combined with surgeon experience can result in successful and safe surgery without a full inpatient admission. This article reviews the data on safety and outcomes for outpatient thyroidectomy and discusses several techniques used to minimize risk to patients.
KEYWORDS: Hematoma; Outpatient thyroidectomy; Safety; Same day thyroidectomy; Short stay thyroidectomy

Tiroidectomía ambulatoria. Perspectiva del anestesiólogo
Ambulatory thyroidectomy: an anesthesiologist's perspective.
Local Reg Anesth. 2017 Apr 5;10:31-39. doi: 10.2147/LRA.S111554. eCollection 2017.
Thyroidectomy has been performed on an inpatient basis because of concerns regarding postoperative complications. These include cervical hematoma, bilateral recurrent laryngeal nerve injury and symptomatic hypocalcemia. We have reviewed the current available evidence and aimed to collate published data to generate incidence of the important complications. We performed a literature search of Medline, EMBASE and the Cochrane database of randomized trials. One hundred sixty papers were included. Twenty-one papers fulfilled inclusion criteria. Thirty thousand four hundred fifty-three day-case thyroid procedures were included. Ten papers were prospective and 11 retrospective. The incidences of complications were permanent vocal cord paralysis 7/30259 (0.02%), temporary hypocalcemia 129/4444 (2.9%), permanent hypocalcemia 405/29203 (1.39%), cervical hematoma 145/30288 (0.48%) and readmission rate 105/29609 (0.35%). Analysis of cervical hematoma data demonstrated that in only 3/14 cases the hematoma presented as an inpatient, and in the remaining 11/14, it occurred late, with a range of 2-9 days. There is a paucity of data relating to anesthetic techniques associated with ambulatory thyroidectomy. Cost comparison between outpatient and inpatient thyroidectomy was reported in three papers. Cost difference ranged from $676 to $2474 with a mean saving of $1301 with ambulatory thyroidectomy. There is a body of evidence that suggests that ambulatory thyroidectomy in the hands of experienced operating teams within an appropriate setting can be performed with acceptable risk profile. In most circumstances, this will be limited to hemithyroidectomies to reduce or avoid the potential for additional morbidity. We have found little evidence to support the use of one anesthetic technique over another. The rates of hospital admission and readmission related to anesthetic factors appear to be low and predominantly related to pain and postoperative nausea and vomiting. A balanced anesthetic technique incorporating appropriate analgesic and antiemetic regimens is essential to avoid unnecessary hospital admission/readmission.
KEYWORDS: ambulatory; day case; hemithyroidectomy; same day; thyroidectomy
Riesgos de para complicaciones postoperatorias en tiroidectomía total
Risk factors for postoperative complications in total thyroidectomy: A retrospective, risk-adjusted analysis from the National Surgical Quality Improvement Program.
Medicine (Baltimore). 2017 Feb;96(5):e5752. doi: 10.1097/MD.0000000000005752.
Thyroid cancer incidence is increasing, and with it, an increase in total thyroidectomy. There are limited studies comparing outcomes in total thyroidectomy performed in the inpatient versus outpatient setting.The objective of this study was to perform a comparative analysis of risk factors and outcomes of postoperative morbidity and mortality in total thyroidectomy performed as an inpatient versus outpatient surgery.
Recommendations for patient selection for outpatient total thyroidectomies should be modified to account for pre-existing conditions that increase the risk of postoperative morbidity.

Vacante para Anestesiología Pediátrica
El Hospital de Especialidades Pediátricas de León, Guanajuato México 
ofrece un contrato laboral en el departamento de anestesiología 
Informes con la Dra Angélica García Álvarez o al teléfono 477 101 8700 Ext 1028
Foro Internacional de Medicina Crítica
Ciudad de México, Julio 13-15, 2017
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