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01-05-2006

Thyroidectomy Using Monitored Local or Conventional General Anesthesia: An Analysis of Outpatient Surgery, Outcome and Cost in 1,194 Consecutive Cases

Authors: Kathryn Spanknebel, MD, John A. Chabot, MD, Mary DiGiorgi, MS, Kenneth Cheung, PhD, James Curty, John Allendorf, MD, Paul LoGerfo, MD

Published in: World Journal of Surgery | Issue 5/2006

Abstract

Background

Critical appraisal of safety, feasibility, and economic impact of thyroidectomy procedures using local (LA) or general anesthesia (GA) is performed.

Methods

Consecutive patients undergoing thyroidectomy procedures were selected from a prospective database from January 1996 to June 2003 of a single-surgeon practice at a tertiary center. Statistical analyses determined differences in patient characteristics, outcomes, operative data, and length of stay (LOS) between groups. A cohort of consecutive patients treated in 2002–2003 by all endocrine surgeons at the institution was selected for cost analysis.

Results

A total of 1,194 patients underwent thyroidectomy, the majority using LA (n = 939) and outpatient surgery (65%). Female gender (76%), body mass index ≥30 kg/m² (29%), median age (49 years), and cancer diagnosis (45%) were similar between groups. Extent of thyroidectomy (59% total) and concomitant parathyroidectomy (13%) were similarly performed. GA was more commonly utilized for patients with comorbidity [15% vs. 10%, Anesthesia Society of America (ASA) ≥3; P < 0.001], symptomatic goiter (13% vs. 7%; P = 0.004), reoperative cases (10% vs. 6%; P = 0.01), and concomitant lymphadenectomy procedures (15% vs. 3%; P < 0.001). GA was associated with significant increase in LOS ≥24 hours (17 % vs. 4%) or overnight observation (49 % vs. 14%), P < 0.001. Operative room utilization was significantly associated with type of anesthesia (180 min vs. 120 min, GA vs. LA, P < .001) and impacted to a lesser degree by surgeon operative time (89 minutes vs. 76 minutes, GA vs. LA; P = .089). Overall morbidity rates were similar between groups (GA 5.8 % vs. LA 3.2%). The actual total cost (ATC) per case for GA was 48% higher than for LA and 30% higher than the ATC for all procedures (P = 0.006), with the combined weighted average impacted by more LA cases (n = 217 vs. 85).

Conclusion

These data from a large, unselected group of thyroidectomy patients suggest LA results in similar outcomes and morbidity rates to GA. It is likely that associated LA costs are lower.

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Title: Thyroidectomy Using Monitored Local or Conventional General Anesthesia: An Analysis of Outpatient Surgery, Outcome and Cost in 1,194 Consecutive Cases
Authors: Kathryn Spanknebel, MD
John A. Chabot, MD
Mary DiGiorgi, MS
Kenneth Cheung, PhD
James Curty
John Allendorf, MD
Paul LoGerfo, MD
Publication date: 01-05-2006
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 5/2006
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-005-0384-3

At a glance: The STEP trials

Springer Medicine

Thyroidectomy Using Monitored Local or Conventional General Anesthesia: An Analysis of Outpatient Surgery, Outcome and Cost in 1,194 Consecutive Cases

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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