Daycare thyroid surgery: can it be a reality?

Abstract

Background: Day care surgery is the current trend in surgical practice. With increasing population and thereby increasing patient load, reduction in availability of beds, low financial resources and long surgical waiting lists, the concept of “short hospital stay” came into the limelight. Improvement in anesthesia and pain control, minimally invasive surgery and changing attitude of patients to recovery after surgery have all contributed towards the success of this concept. The aim was to assess the post-operative complication of hypocalcaemia while monitoring the pre closure PTH values, postoperative hypocalcaemia, and other post-operative complications, and thus arriving at feasibility of doing thyroid surgery as a day case surgery. Methods: A retrospective case control study over a period of one year conducted at medical college of Trivandrum including 40 patients and 100 controls selected with strict inclusion and exclusion criteria. The pre-closure Para Thyroid Hormone (PTH) levels were obtained just before wound closure using the electrochemilumescence immunoassay. Ionized calcium (Ca 2+ ) levels were assessed postoperatively on postoperative day 1, day 2 and day 3.the post-operative hypocalcaemia was monitored both clinically and with lab parameters The results obtained were tabulated. Statistical analysis was done with SPSS software package version 17.0 for windows. Results: By applying ROC curve for analysis of pre-closure PTH assay there is 96% sensitivity and 100% specificity in predicting acute hypocalcaemia. Conclusions: By doing a pre-closure PTH assay is feasible to predict post- operative hypocalcaemia and so thyroid surgeries can be done as a planned day case surgery.