scholarly journals Questionable safety of thyroid surgery with same day discharge

2012 ◽  
Vol 94 (8) ◽  
pp. 543-547 ◽  
Author(s):  
HE Doran ◽  
J England ◽  
F Palazzo
Keyword(s):  
Surgical Procedures ◽  
Thyroid Surgery ◽  
Evidence Base ◽  
Day Surgery ◽  
Hospital Environment ◽  
British Association ◽  
Outpatient Basis ◽  
Day Case ◽  
Increased Risk ◽  
Same Day Discharge

INTRODUCTION 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

Introducing day case thyroid lobectomy at a tertiary head and neck centre

2021 ◽  
Vol 103 (7) ◽  
pp. 499-503
Author(s):  
Z Sheikh ◽  
V Lingamanaicker ◽  
E Irune ◽  
B Fish ◽  
P Jani
Keyword(s):  
Cost Effective ◽  
Day Surgery ◽  
British Association ◽  
Day Case ◽  
Thyroid Lobectomy ◽  
Number Of Patients ◽  
Same Day Discharge ◽  
Postoperative Haematoma ◽  
The Uk ◽  
Disseminated Disease

Background Thyroid lobectomy is considered to be a safe day case procedure by the British Association of Day Surgery. However, currently only 5.5% of thyroid surgeries in the UK are undertaken as day cases. We determine if and how thyroid lobectomy with same-day discharge could safely be introduced in our centre. Methods We analysed all thyroid lobectomy surgeries performed between April 2015 and May 2019. Exclusion criteria included completion surgery, revision surgery, additional procedures and disseminated disease. Outcomes were benchmarked against surgeon-reported complications from the British Association of Endocrine and Thyroid Surgery’s 5th National Audit. Additionally, we reviewed the number of patients who met day case criteria currently in use at our hospital to determine accessibility to the service. Results In total, 259 thyroid lobectomy surgeries were undertaken and of these 173 met the inclusion criteria. There was no mortality, return to theatre for evacuation of postoperative haematoma or readmission. There was one postoperative haematoma which was drained at the bedside. Some 47 of the 173 (27.2%) patients met day case criteria currently in use at our centre. Conclusions Day case surgery provides a cost-effective solution to rising bed pressures and a coherent protocol can optimise patient safety and experience.

Day-case tonsillectomy: is the NHS demanding unobtainable targets?

2014 ◽  
Vol 96 (6) ◽  
pp. 188-190
Author(s):  
A Trinidade ◽  
JS Phillips ◽  
AP Bath
Keyword(s):  
Surgical Procedures ◽  
Day Surgery ◽  
British Association ◽  
Day Case ◽  
Department Of Health ◽  
Audit Commission

In its 2002 document Delivering the NHS Plan, the Department of Health set a target of 75% of all surgical procedures being performed as day-case procedures. 1 Tonsillectomy is quoted as one of the operations in the ‘basket’ of 25 procedures deemed suitable by the Audit Commission and the British Association of Day Surgery (BADS). 2 , 3 With respect to tonsillectomy alone, the target is quoted as 70% for children and 80% for adults. 3

Post-thyroidectomy bleeding: analysis of risk factors from a national registry

2021 ◽  
Author(s):  
H E Doran ◽  
S M Wiseman ◽  
F F Palazzo ◽  
D Chadwick ◽  
S Aspinall
Keyword(s):  
Risk Factors ◽  
Total Thyroidectomy ◽  
Thyroid Surgery ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Bleeding Risk ◽  
Redo Surgery ◽  
Day Case ◽  
Increased Risk ◽  
Male Sex

Abstract Background Post-thyroidectomy haemorrhage occurs in 1–2 per cent of patients, one-quarter requiring bedside clot evacuation. Owing to the risk of life-threatening haemorrhage, previous British Association of Endocrine and Thyroid Surgeons (BAETS) guidance has been that day-case thyroidectomy could not be endorsed. This study aimed to review the best currently available UK data to evaluate a recent change in this recommendation. Methods The UK Registry of Endocrine and Thyroid Surgery was analysed to determine the incidence of and risk factors for post-thyroidectomy haemorrhage from 2004 to 2018. Results Reoperation for bleeding occurred in 1.2 per cent (449 of 39 014) of all thyroidectomies. In multivariable analysis male sex, increasing age, redo surgery, retrosternal goitre and total thyroidectomy were significantly correlated with an increased risk of reoperation for bleeding, and surgeon monthly thyroidectomy rate correlated with a decreased risk. Estimation of variation in bleeding risk from these predictors gave low pseudo-R2 values, suggesting that bleeding is unpredictable. Reoperation for bleeding occurred in 0.9 per cent (217 of 24 700) of hemithyroidectomies, with male sex, increasing age, decreasing surgeon volume and redo surgery being risk factors. The mortality rate following thyroidectomy was 0.1 per cent (23 of 38 740). In a multivariable model including reoperation for bleeding node dissection and age were significant risk factors for mortality. Conclusion The highest risk for bleeding occurred following total thyroidectomy in men, but overall bleeding was unpredictable. In hemithyroidectomy increasing surgeon thyroidectomy volume reduces bleeding risk. This analysis supports the revised BAETS recommendation to restrict day-case thyroid surgery to hemithyroidectomy performed by high-volume surgeons, with caution in the elderly, men, patients with retrosternal goitres, and those undergoing redo surgery.

Day-case tonsillectomy for children in Glasgow: the impact of changing indications and deprivation

2013 ◽  
Vol 127 (4) ◽  
pp. 392-398 ◽  
Author(s):  
W A Clement
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Day Surgery ◽  
Sleep Apnoea ◽  
Day Case ◽  
Sleep Related Breathing Disorders ◽  
Number Of Children ◽  
Breathing Disorders ◽  
Obstructive Sleep ◽  
Same Day Discharge ◽  
The Impact

AbstractObjective:To determine the number of children undergoing tonsillectomy that could have this performed as a day surgery procedure.Methods:This paper reports a prospective cohort study, which entailed a comparison of children's eligibility for day-case surgery between 2001 and 2011 and an assessment of the Scottish Index of Multiple Deprivation scores.Results:In total, 148 children were enrolled. In 2011, 60 children (42 per cent) were eligible for surgery with same day discharge compared with 27 per cent in 2001. The percentage of children undergoing tonsillectomy for sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome increased from 26 per cent to 55 per cent.Conclusion:Eligibility for tonsillectomy with same day discharge has increased. This appears to be related to an increase in the number of children who are able to fulfil the social criteria for same day discharge. The results indicate an association between deprivation and tonsillectomy, particularly surgery carried out for the symptoms of sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome. There has been a significant increase in the percentage of children undergoing tonsillectomy for the indication of sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome.

scholarly journals P71 Investigating the rate of successful day case discharges for laparoscopic cholecystectomies between June-November 2019

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Rohan Andrew Pancharatnam ◽  
Sheryl Abraham ◽  
Anjolaoluwa Adeniran ◽  
Jonathan Candan ◽  
Rohan Pancharatnam
Keyword(s):  
Standard Treatment ◽  
Day Surgery ◽  
Success Rates ◽  
Day Case ◽  
Retrospective Data Analysis ◽  
Same Day Discharge ◽  
Significant Difference ◽  
Symptomatic Gallstones ◽  
Overnight Stays ◽  
Operation Scheduling

Abstract Introduction Laparoscopic Cholecystectomy (LC) is the gold standard treatment for symptomatic gallstones. The British Association of Day Surgery (BADS) recommend that at least 60% of LCs are performed as day cases. We investigated the rate of successful discharge for LCs and factors contributing to unexpected overnight stays. Methods Retrospective data analysis was performed on elective LCs between June-November 2019. Electronic records were reviewed for: admission and discharge date; time of procedure; length of procedure; training grade of the surgeon; use of total intravenous anaesthesia (TIVA) or volatile anaesthesia; use of IV morphine in theatre/recovery and reasons for failed discharge. Results A total of 119 patients underwent elective LC, of which 63 were planned day cases. 46 patients (73.0%) listed as day cases were successfully discharged the same day. LCs performed before 1pm had a success rate of 78.8% compared to 45.5% after 1pm (p < 0.05). There was no statistically significant difference in success rates due to length of procedure; training grade of the surgeon; method of induction (TIVA or Volatile) or use of IV morphine in theatre/recovery. 17 planned day cases failed same day discharge. 7 of these patients (41.2%) reported pain and 4 (23.3%) reported nausea, vomiting or dizziness. Conclusion This centre successfully discharged 73.0% of planned day case LCs, although only 52.9% of elective LCs were listed as day cases. Success rates were positively associated with am procedures compared to pm. We recommend a review of operation scheduling and evening staffing in order to increase the probability of discharge on the same day.

Admission and discharge policy for paediatric adenoidectomy and tonsillectomy – a rural perspective

1998 ◽  
Vol 112 (11) ◽  
pp. 1047-1051 ◽  
Author(s):  
P. Murthy ◽  
M. R. Laing
Keyword(s):  
General Practitioners ◽  
Surgical Procedures ◽  
Nursing Staff ◽  
Prospective Audit ◽  
Day Case ◽  
Discharge Policy ◽  
Same Day Discharge

AbstractAdenoidectomy and tonsillectomy are amongst the most common surgical procedures carried out in children. We undertook a prospective audit in the Highlands of Scotland to document the views of general practitioners, parents, nursing staff and anaesthetists on admission and discharge policy. Of responses from 149 general practitioners, 119 (80 per cent) were in favour of change to same day admission and 22 (15 per cent) were not in favour. For change to same day discharge for adenoidectomy, 55 (37 per cent) were in favour and 81(54 per cent) were not in favour. For change to next day discharge for tonsillectomy, the figures were 51(34 per cent) and 89 (60 per cent) respectively. Responses from 14 trained paediatric nurses comprised 13 not in favour of same day admission, six in favour and seven not in favour of same day discharge for adenoidectomy and all 14 not in favour of same day discharge for tonsillectomy. All eight Consultant anesthaetists approached were happy with a change in policy to same day admission for children who were otherwise fit and well. Thirty-seven parents (70 per cent) preferred previous day admission and 14 (29 per cent) were happy with same day admission for their children. On the basis of these results, day-case adenoidectomy or tonsillectomy is not being considered in this area. Moves have been made, however, toward a policy of same day admission and next day discharge.

Is thyroid surgery performed too often in Germany?

2015 ◽  
Vol 54 (03) ◽  
pp. 101-105 ◽  
Author(s):  
F. A. Verburg
Keyword(s):  
Surgical Procedures ◽  
Thyroid Surgery ◽  
Needle Biopsy ◽  
Fine Needle Biopsy ◽  
Contributing Factors ◽  
Fine Needle ◽  
Diagnostic Measures ◽  
Frequent Use ◽  
Preoperative Diagnostic ◽  
The Usa

SummaryThyroid surgery is one of the more common surgical procedures in Germany. This is in contrast with the situation in some other countries, where this procedure is performed comparatively rarely. In this paper the number of thyroid surgeries in Germany is compared with other western countries (Netherlands, USA, England). In contrast to e. g. the USA and England the number of thyroid surgeries in Germany is declining, however with approximately 109/100 000/year in 2012 is still elevated (Netherlands: 16/100 000/year, USA: at least 42/100 000/year, England: at least 27/100 000/year).Possible contributing factors to this higher number of thyroid surgeries in Germany are explored. These factors include iodine deficiency, the frequent use of advanced diagnostics such as ultrasound, insufficient use of preoperative diagnostic measures such as fine needle biopsy and the practice of “defensive medicine”. How much each of these factors contributes is however unclear.

scholarly journals 62 A Retrospective Observational Study Into the Correct Administration of Rivaroxaban: Is it Being Taken with Food?

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
E Spurring ◽  
G Donnelly
Keyword(s):  
Drug Safety ◽  
Healthcare Professionals ◽  
Hospital Environment ◽  
Electronic Prescribing ◽  
Academic Knowledge ◽  
Increased Risk ◽  
Swallowing Difficulties ◽  
The Difference ◽  
Medical Wards ◽  
Hospitalised Patient

Abstract Intro In July 2019 the MHRA issued a drug safety update reminding healthcare professionals that rivaroxaban should be taken with food. This came after they received a number of thromboembolic events reported in patients prescribed rivaroxaban, thought to be linked with incorrect ingestion on an empty stomach [1]. Our aim was to establish if the healthcare professionals in our department had this knowledge and to audit our current dispensing practice to assess if our hospitalised patient cohort were being exposed to any increased risk. Methods A retrospective study was conducted using electronic data from 21 patients that were prescribed rivaroxaban across 14 medical wards. A questionnaire was used to establish the staff’s knowledge. Results Of the surveyed healthcare professionals, 79% knew that rivaroxaban should be taken with food (86% of nurses and 79% of doctors). Despite this only 17% of patients took the tablet with food. 75% of patients had rivaroxaban incorrectly dispensed over an hour post meal and 8% were uncertain due to poor documentation. Only 14% of healthcare professionals were aware that in those with swallowing difficulties, rivaroxaban can be crushed. Conclusions In our department most of the healthcare professionals had a good academic knowledge of correct rivaroxaban administration, however we have demonstrated that this is failing to correctly influence clinical practice. 75% of patients taking Rivaroxaban in hospital are being subjected to increased risk due to the hospital environment. This was found to relate to the difference in timing of the drug dispensing round in comparison to meal times. As part of the roll out of electronic prescribing in our trust, a warning now shows when both prescribing and dispensing Rivaroxaban to attempt to improve this highlighted risk. We have also highlighted this to the ward managers and at our governance meeting. Reference 1. Drug Safety Update volume 12, issue 12: July 2019: 3.

INAHTA IMPACT STORY: LEGISLATIVE AND ACCREDITATION REQUIREMENTS FOR OFFICE-BASED SURGERY IN AUSTRALIA

2017 ◽  
Vol 33 (4) ◽  
pp. 434-441 ◽  
Author(s):  
David Tivey ◽  
Ning Ma ◽  
Joanna Duncan ◽  
Yasoba Atukorale ◽  
Robyn Lambert ◽  
...  
Keyword(s):  
Web Sites ◽  
Day Surgery ◽  
Accreditation Process ◽  
Rapid Review ◽  
Regulatory Oversight ◽  
Serious Adverse Events ◽  
Healthcare Facilities ◽  
Government Web Sites ◽  
Increased Risk ◽  
Reimbursement Scheme

Background:There is growing trend for some surgical procedures previously performed in hospitals to be done in alternative settings, including office-based facilities. There has been some safety concerns reported in the media, which document serious adverse events following procedures performed in an office-based setting. To understand the current regulatory oversight of surgery in this setting ASERNIP-S conducted a review of the legislative and accreditation process governing these facilities in Australia.Methods:Using rapid review methodology, internet searches targeted government Web sites for relevant publicly-available documents. Use of consolidated versions of legislative instruments ensured currency of information. Standards were sourced directly from the issuing authorities or those that oversee the accreditation process.Results:Within Australia, healthcare facilities for surgery and their licensing are defined by each state and territory, which results in significant jurisdictional variation. These variations relate to the need for anesthesia beyond conscious sedation and listing of procedures in legislative instruments. In 2013, Australia adopted National Safety and Quality Health Service standards (NSQHS standards) for the accreditation of hospitals and day surgery centers; however, there is no NSQHS standard for office-based facilities. The main legislative driver for compliance is access to reimbursement schemes for service delivery.Conclusions:The legislative and accreditation framework creates a situation whereby healthcare facilities that provide services outside the various legal definitions of surgery and those not covered by a reimbursement scheme, can operate without licensing and accreditation oversight. This situation exposes patients to potential increased risk of harm when receiving treatment in such unregulated facilities.

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