Thyroidectomy Using Monitored Local or Conventional General Anesthesia: An Analysis of Outpatient Surgery, Outcome and Cost in 1,194 Consecutive Cases
Critical appraisal of safety, feasibility, and economic impact of thyroidectomy procedures using local (LA) or general anesthesia (GA) is performed.
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.
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).
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.
KeywordsLocal Anesthesia Goiter Recurrent Laryngeal Nerve Injury General Anesthesia Group Conventional Thyroidectomy
With gratitude and appreciation, we wish to acknowledge colleagues and staff at the New York Thyroid Center, especially Bonnie Badenchini, Mary DiGiorgi, Diana Hernandez, and Dianna Walsh who, with dedication and devotion, supported the patients, professional practice, and research endeavors of Paul LoGerfo and to whom we owe much to the completion of his work.
- 15.LoGerfo P. Local/regional anesthesia for thyroidectomy: evaluation as an outpatient procedure. Surgery 1998;124:975–978Google Scholar
- 17.LoGerfo P, Kim LJ. Technique for regional anesthesia: thyroidectomy and parathyroidectomy. Oper Tech Gen Surg 1999;1:95–102Google Scholar
- 19.LoGerfo P, Gates R, Gazetas P. Outpatient and short-stay thyroid surgery. Head Neck 1991;13:97–101Google Scholar
- 23.Hundahl SA, Cady B, Cunningham MP, et al. Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the united states during 1996. U.S. and German Thyroid Cancer Study Group. An American College of Surgeons Commission on Cancer Patient Care Evaluation study. Cancer 2000;89:202–217CrossRefPubMedGoogle Scholar
- 48.Udelsman R. Experience counts. Ann Surg 2004;26–27Google Scholar
- 52.Kohn KT, Corrigan JM, Donaldson MS. To err is human: Building a safer health system. Washington, DC, National Academy Press, 1999Google Scholar
- 60.Testini M, Nacchiero M, Miniello S, et al. One-day vs standard thyroidectomy. A perspective study of feasibility. Minerva Endocrinol 2002;29:225–229Google Scholar