Potential Advantages of Outpatient

Potential Advantages of Outpatient Thyroidectomy
The potential advantages associated with outpatient thyroidectomy fall into the following broad categories: patient safety, patient comfort, and conservation of resources.

The patient's health and safety remain paramount during recovery from any operation. The reality of the hospital environment necessarily exposes the patient to the risk of nosocomial infections with drug-resistant organisms, such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococcus, or multidrug-resistant tuberculosis (20). Furthermore, an imperfect system of patient care in the hospital environment also exposes the patient to a host of potential iatrogenic complications that may be avoided with outpatient management. An Institute of Medicine report in 1999 (To Err Is Human) (21) estimated that approximately 98,000 deaths occur each year in American hospitals as a result of these iatrogenic complications. Many patients prefer outpatient surgery from a comfort and convenience perspective. Convalescence in a quiet, comfortable, and familiar setting with supportive family and friends may be preferable to a less quiet, interruptive, and unfamiliar hospital environment. Patients are generally receptive to the notion of outpatient thyroidectomy, particularly if proper patient education and counseling are pursued to mitigate fears and uncertainties in preparation for the outpatient process. A protocol of postoperative assessment in the surgery unit ensures that the patient, family, and friends are adequately prepared for the outpatient experience before discharge.

The U.S. healthcare industry remains under increased scrutiny to maintain quality patient care at reduced cost. Each day a patient spends in the hospital incurs fixed and variable expenses that will differ over sections of the country and from urban to rural settings. Maximizing the efficiency of outpatient surgery serves to minimize utilization of critical hospital resources that may instead be reallocated to other important needs. Furthermore, a gradual transition of some thyroidectomies from an inpatient procedure to an outpatient setting may impart considerable healthcare savings nationwide. Published studies have demonstrated a reduction in charges associated with outpatient thyroidectomy compared with inpatient surgery, which approaches $2500 per encounter (8,13). These savings not only accrue to medical facilities, insurance companies, and the government, but directly benefit the patient as well, since few health insurance plans cover 100% of incurred expenses, with most requiring the patient to pay a percentage of the expenses. Some health insurance plans charge the patient a fixed copay for each day spent in the hospital. Such incentives have naturally created an attitude change in some patients in favor of outpatient surgery.

The advantages of outpatient thyroidectomy may be realized once the patient's safety and comfort in the outpatient setting are optimized. Although not all thyroidectomy procedures can be managed on an outpatient basis, it is worth identifying those patients and procedures for which it is reasonable, and recommending precautions for pursuing it safely.