DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20200771

The outcome of short stay thyroidectomy in rural medical outreach settings in Northern Nigeria

Alexander F. Ale, Mercy W. Isichei, Michael A. Misauno

Abstract


Background: The practice of short stay thyroidectomy is relatively new in developing nations like Nigeria. The primary reason for this is a lack of resources. Furthermore, the prevailing poverty prevents many patients from accessing tertiary health care, as such, ad hoc medical outreaches are usually conducted to bridge the gap. Thyroidectomies have not been routinely performed in these outreach settings due to safety concerns. The study seeks to analyse whether short stay thyroidectomy can be safely practiced under medical outreach settings with limited resources.

Methods: The study is a prospective review of all patients that had short stay thyroidectomy at four rural medical outreach settings in Nigeria. Entire study spanned January 2019 to November 2019. Each outreach lasted one week, and patients were followed up for the duration of the outreach. All patients presenting at the outreach locations and diagnosed with goiters who have had no prior neck surgeries, are euthyroid, have no locally advanced malignancies or intrathoracic goiters, have adequate social support, possess a telephone, and have accommodation within the local government area where the outreach is carried out were included in the study. Exclusion criteria included patients who did not satisfy any of the above listed inclusion criteria. Thyroidectomy was done through a standard cervicotomy. Descriptive statistics were applied.

Results: A total of 81 patients with non-toxic goiters had thyroid surgery. There were 76 (94%) females and five (6%) males. Average age was 46 years. Sixty-nine (85.2%) patients had no complication, while 12 (14.8%) patients had complications. Seventy-seven (95.1%) patients were discharged within 24 hours of surgery, while four (9.4%) patients were discharged within 48 hours. There was no mortality.

Conclusions: The short-stay thyroidectomy model is feasible and safe in our environment, even in the presence of limited resources, and provides an alternative to the traditional 72 hour postoperative hospital stay.


Keywords


Complications, Resource-poor, Short stay, Thyroidectomy

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References


Dedivitis RA, Pfuetzenreiter EG, Castro MA, Denardin OV. Analysis of safety of short-stay thyroid surgery. Acta Otorhinolaryngol Ital. 2009;29(6):326-30.

Balentine CJ, Sippel RS. Outpatient thyroidectomy: is it safe? Surg Oncol Clin N Am. 2016;25(1):61-75.

Nouraei SA, Virk JS, Middleton SE. A national analysis of trends, outcomes and volume-outcome relationships in thyroid surgery. Clin Otolaryngol. 2017;42(2):354-65.

Narayanan S, Arumugam D, Mennona S, Wang M, Davidov T, Trooskin SZ. An evaluation of postoperative complications and cost after short-stay thyroid operations. Ann Surg Oncol. 2016;23(5):1440-5.

Materazzi G, Dionigi G, Berti P. One-day thyroid surgery: retrospective analysis of safety and patient satisfaction on a consecutive series of 1,571 cases over a three-year period. Eur Surg Res. 2007;39(3):182-8.

Perera AH, Patel SD, Law NW. Thyroid surgery as a 23-hour stay procedure. Ann R Coll Surg Engl. 2014;96(4):284-8.

Raspanti C, Porrello C, Augello G. 23-hour observation endocrine neck surgery: lessons learned from a case series of over 1700 patients. G Chir. 2017;38(1):15-22.

Bansal N, Yadav SK, Mishra SK, et al. Short Stay thyroid surgery: can we replicate the same in low resource setting? J Thyroid Res. 2018;18:49-51.

Yerzingatsian KL. Short-stay thyroidectomy--trends in length of postoperative hospitalisation over a period of 10 years in a developing country central hospital. S Afr J Surg. 2002;40(2):81.

Gerfo LP, Gates R, Gazetas P. Outpatient and short-stay thyroid surgery. Head Neck. 1991;13(2):97-101.

Cannizzaro MA, Caruso L, Costanzo M, Messina D, Sallemi R, Veroux M. Surgery of thyroid pathologies in one-day surgery. Ann Ital Chir. 2002;73(5):501-3.

Dionigi G, Rovera F, Carrafiello G, Boni L, Dionigi R. Ambulatory thyroid surgery: need for stricter patient selection criteria. Int J Surg. 2008;6(1):19-21.

Gatek J, Dudesek B, Duben J. Is thyroid and parathyroid surgery safe? Is it suitable for one-day surgery? Rozhl Chir. 2014;93(1):21-7.

Bliss RD, Gauger PG, Delbridge LW. Surgeon's approach to the thyroid gland: surgical anatomy and the importance of technique. World J Surg. 2000;24(8):891-7.

Gong S, Zhang H, Liu Y, Zhang Q, Yu Z. Preliminary report on meticulous operation of thyroid lobectomy. Tou Jing Wai Ke Za Zhi. 2015;50(1):28-32.

Cannizzaro MA, Bianco LS, Picardo MC, Provenzano D, Buffone A. How to avoid and to manage post-operative complications in thyroid surgery. Updates Surg. 2017;69(2):211-5.

Lee HS, Lee BJ, Kim SW. Patterns of post-thyroidectomy hemorrhage. Clin Exp Otorhinolaryngol. 2009;2(2):72-7.

Farooq MS, Nouraei R, Kaddour H, Saharay M. Patterns, timing and consequences of post-thyroidectomy haemorrhage. Ann R Coll Surg Engl. 2017;99(1):60-2.

Doran HE, England J, Palazzo F. Questionable safety of thyroid surgery with same day discharge. Ann R Coll Surg Engl. 2012;94(8):543-7.

Materazzi G, Ambrosini CE, Fregoli L. Prevention and management of bleeding in thyroid surgery. Gland Surg. 2017;6(5):510-5.

Rosenbaum MA, Haridas M, Henry CR. Life-threatening neck hematoma complicating thyroid and parathyroid surgery. Am J Surg. 2008;195(3):339-43.

Agarwal A, Mishra AK, Gupta SK. High incidence of tracheomalacia in longstanding goiters: experience from an endemic goiter region. World J Surg. 2007;31(4):832-7.

Rahim AA, Ahmed ME, Hassan MA. Respiratory complications after thyroidectomy and the need for tracheostomy in patients with a large goitre. Br J Surg. 1999;86(1):88-90.

Agarwal A, Agarwal S, Tewari P. Clinicopathological profile, airway management, and outcome in huge multinodular goiters: an institutional experience from an endemic goiter region. World J Surg. 2012;36(4):755-60.

Inabnet WB, Shifrin A, Ahmed L, Sinha P. Safety of same day discharge in patients undergoing sutureless thyroidectomy: a comparison of local and general anesthesia. Thyroid. 2008;18(1):57-61.

Sanchez BJM, Moyano RG, Delgado GA, Rubio D, Jimenez JR, Arcos JC. Thyroidectomy in the ambulatory setting: a prospective study. Cir Esp. 2006;80(4):206-13.

Spanknebel K, Chabot JA, Giorgi M. Thyroidectomy using local anesthesia: a report of 1,025 cases over 16 years. J Am Coll Surg. 2005;201(3):375-85.

Stephen E, Nayak S, Salins SR. Thyroidectomy under local anaesthesia in India. Trop Doct. 2008;38(1):20-1.

Musa AA, Lasisi OA, Fatungase OM, Oyegunle OA. General and regional anaesthesia for thyroidectomy in rural/semi-urban Nigerian centres. East Afr Med J. 2009;86(6):287-90.

Misauno MA, Yilkudi MG, Akwaras AL. Thyroidectomy under local anaesthesia: how safe? Niger J Clin Pract. 2008;11(1):37-40.

Banasiewicz T, Meissner W, Pyda P. Local anesthesia in thyroid surgery own experience and literature review. Pol Przegl Chir. 2011;83(5):264-70.

Calo PG, Tatti A, Farris S, Nicolosi A. Length of hospital stay and complications in thyroid surgery: our experience. Chir Ital. 2007;59(2):149-53.

Noureldine SI, Genther DJ, Lopez M, Agrawal N, Tufano RP. Early predictors of hypocalcemia after total thyroidectomy: an analysis of 304 patients using a short-stay monitoring protocol. Otolaryngol Head Neck Surg. 2014;140(11):1006-13.

Khanzada TW, Samad A, Memon W, Kumar B. Post thyroidectomy complications: the Hyderabad experience. J Ayub Med Coll Abbottabad. 2010;22(1):65-8.