Skip to main content
SpringerLink
Log in

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

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

ReferenceS

  1. Spanknebel K, Chabot JA, DiGiorgi M, et al. Thyroidectomy using local anesthesia: a report of 1,025 cases over 16 years. J Am Coll Surg 2005;201:375–385

    Article  PubMed  Google Scholar 

  2. Cunningham IG, Lee YK. The management of solitary thyroid nodules under local anaesthesia. Aust N Z J Surg 1975;45:285–289

    CAS  PubMed  Google Scholar 

  3. Fernandez FH. Cervical block anesthesia in thyroidectomy. Int Surg 1984;69:309–311

    CAS  PubMed  Google Scholar 

  4. Saxe AW, Brown E, Hamburger SW. Thyroid and parathyroid surgery performed with patient under regional anesthesia. Surgery 1988;103:415–420

    CAS  PubMed  Google Scholar 

  5. Hochman M, Fee WE Jr. Thyroidectomy under local anesthesia. Arch Otolaryngol Head Neck Surg 1991;117:405–407

    CAS  PubMed  Google Scholar 

  6. Kulkarni RS, Braverman LE, Patwardhan NA. Bilateral cervical plexus block for thyroidectomy and parathyroidectomy in healthy and high risk patients. J Endocrinol Invest 1996;19:714–718

    CAS  PubMed  Google Scholar 

  7. Samson PS, Reyes FR, Saludares WN, et al. Outpatient thyroidectomy. Am J Surg 1997;173:499–503

    Article  CAS  PubMed  Google Scholar 

  8. Prasad KC, Shanmugam VU. Major neck surgeries under regional anesthesia. Am J Otolaryngol 1998;19:163–169

    Article  CAS  PubMed  Google Scholar 

  9. Specht MC, Romero M, Barden CB, et al. Characteristics of patients having thyroid surgery under regional anesthesia. J Am Coll Surg 2001;193:367–372

    Article  CAS  PubMed  Google Scholar 

  10. Hisham AN, Aina EN. A reappraisal of thyroid surgery under local anaesthesia: back to the future? ANZ J Surg 2002;72:287–289

    Article  PubMed  Google Scholar 

  11. Steckler RM. Outpatient thyroidectomy: a feasibility study. Am J Surg 1986;152:417–419

    Article  CAS  PubMed  Google Scholar 

  12. Marohn MR, LaCivita KA. Evaluation of total/near-total thyroidectomy in a short-stay hospitalization: safe and cost-effective. Surgery 1995;118:943–947

    CAS  PubMed  Google Scholar 

  13. Mowschenson PM, Hodin RA. Outpatient thyroid and parathyroid surgery: a prospective study of feasibility, safety, and costs. Surgery 1995;118:1051–1053

    CAS  PubMed  Google Scholar 

  14. McHenry CR. “Same-day” thyroid surgery: an analysis of safety, cost savings, and outcome. Am Surg 1997;63:586–589

    CAS  PubMed  Google Scholar 

  15. LoGerfo P. Local/regional anesthesia for thyroidectomy: evaluation as an outpatient procedure. Surgery 1998;124:975–978

    CAS  Google Scholar 

  16. Schwartz AE, Clark OH, Ituarte P, et al. Therapeutic controversy: thyroid surgery–the choice. J Clin Endocrinol Metab 1998;83:1097–1105

    Article  CAS  PubMed  Google Scholar 

  17. LoGerfo P, Kim LJ. Technique for regional anesthesia: thyroidectomy and parathyroidectomy. Oper Tech Gen Surg 1999;1:95–102

    Google Scholar 

  18. Williams M, LoGerfo P. Thyroidectomy using local anesthesia in critically ill patients with amiodarone-induced thyrotoxicosis: a review and description of the technique. Thyroid 2002;12:523–525

    Article  PubMed  Google Scholar 

  19. LoGerfo P, Gates R, Gazetas P. Outpatient and short-stay thyroid surgery. Head Neck 1991;13:97–101

    CAS  Google Scholar 

  20. LoGerfo P, Ditkoff BA, Chabot J, et al. Thyroid surgery using monitored anesthesia care: an alternative to general anesthesia. Thyroid 1994;4:437–439

    Article  CAS  Google Scholar 

  21. Foster RS Jr. Morbidity and mortality after thyroidectomy. Surg Gynecol Obstet 1978;146:423–429

    PubMed  Google Scholar 

  22. Hundahl SA, Fleming ID, Fremgen AM, et al. A national cancer data base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985–1995 [see comments]. Cancer 1998;83:2638–2648

    Article  CAS  PubMed  Google 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;89:202–217

    Article  CAS  PubMed  Google Scholar 

  24. Thomusch O, Machens A, Sekulla C, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 2000;24:1335–1341

    Article  CAS  PubMed  Google Scholar 

  25. Rosato L, Avenia N, Bernante P, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 2004;28:271–276

    Article  PubMed  Google Scholar 

  26. Goncalves FJ, Kowalski LP. Surgical complications after thyroid surgery performed in a cancer hospital. Otolaryngol Head Neck Surg 2005;132:490–494

    Article  Google Scholar 

  27. Shen WT, Kebebew E, Duh QY, et al. Predictors of airway complications after thyroidectomy for substernal goiter. Arch Surg 2004;139:656–659

    Article  PubMed  Google Scholar 

  28. Rios A, Rodriguez JM, Canteras M, et al. Surgical management of multinodular goiter with compression symptoms. Arch Surg 2005;140:49–53

    Article  PubMed  Google Scholar 

  29. Zambudio AR, Rodriguez J, Riquelme J, et al. Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Ann Surg 2004;240:18–25

    Article  PubMed  Google Scholar 

  30. Erbil Y, Bozbora A, Barbaros U, et al. Surgical management of substernal goiters: clinical experience of 170 cases. Surg Today 2004;34:732–736

    Article  PubMed  Google Scholar 

  31. Patel KN, Shaha AR. Locally advanced thyroid cancer. Curr Opin Otolaryngol Head Neck Surg 2005;13:112–116

    Article  PubMed  Google Scholar 

  32. Kikuchi S, Perrier ND, Cheah WK, et al. Complication of thyroidectomy in patients with radiation-induced thyroid neoplasms. Arch Surg 2004;139:1185-1188

    Article  PubMed  Google Scholar 

  33. Nakao K, Kurozumi K, Nakahara M, et al. Resection and reconstruction of the airway in patients with advanced thyroid cancer. World J Surg 2004;28:1204–1206

    Article  PubMed  Google Scholar 

  34. Ferrier MB, Spuesens EB, Le Cessie S, et al. Comorbidity as a major risk factor for mortality and complications in head and neck surgery. Arch Otolaryngol Head Neck Surg 2005;131:27–32

    Article  PubMed  Google Scholar 

  35. Franzese CB, Fan CY, Stack BC Jr. Surgical management of amiodarone-induced thyrotoxicosis. Otolaryngol Head Neck Surg 2003;129:565–570

    Article  PubMed  Google Scholar 

  36. Houghton SG, Farley DR, Brennan MD, et al. Surgical management of amiodarone-associated thyrotoxicosis: Mayo Clinic experience. World J Surg 2004;28:1083–1087

    Article  PubMed  Google Scholar 

  37. Mittendorf EA, McHenry CR. Thyroidectomy for selected patients with thyrotoxicosis. Arch Otolaryngol Head Neck Surg 2001;127:61–65

    CAS  PubMed  Google Scholar 

  38. Otto RA, Cochran CS. Sensitivity and specificity of intraoperative recurrent laryngeal nerve stimulation in predicting postoperative nerve paralysis. Ann Otol Rhinol Laryngol 2002;111:1005–1007

    PubMed  Google Scholar 

  39. Marcus B, Edwards B, Yoo S, et al. Recurrent laryngeal nerve monitoring in thyroid and parathyroid surgery: the University of Michigan experience. Laryngoscope 2003;113:356–361

    Article  PubMed  Google Scholar 

  40. Scheuller MC, Ellison D. Laryngeal mask anesthesia with intraoperative laryngoscopy for identification of the recurrent laryngeal nerve during thyroidectomy. Laryngoscope 2002;112:1594–1597

    Article  PubMed  Google Scholar 

  41. Hermann M, Hellebart C, Freissmuth M. Neuromonitoring in thyroid surgery: prospective evaluation of intraoperative electrophysiological responses for the prediction of recurrent laryngeal nerve injury. Ann Surg 2004;240:9–17

    Article  PubMed  Google Scholar 

  42. Witt RL. Electrophysiologic monitoring of the recurrent laryngeal nerves may not predict bilateral vocal fold immobility after thyroid surgery. J Voice 2004;18:256–260

    Article  PubMed  Google Scholar 

  43. Beldi G, Kinsbergen T, Schlumpf R. Evaluation of intraoperative recurrent nerve monitoring in thyroid surgery. World J Surg 2004;28:589–591

    Article  PubMed  Google Scholar 

  44. Sosa JA, Bowman HM, Tielsch JM, et al. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 1998;228:320–330

    Article  CAS  PubMed  Google Scholar 

  45. Mishra A, Agarwal G, Agarwal A, et al. Safety and efficacy of total thyroidectomy in hands of endocrine surgery trainees. Am J Surg 1999;178:377–380

    Article  CAS  PubMed  Google Scholar 

  46. Bliss RD, Gauger PG, Delbridge LW. Surgeon’s approach to the thyroid gland: surgical anatomy and the importance of technique. World J Surg 2000;24:891–897

    Article  CAS  PubMed  Google Scholar 

  47. Acun Z, Cihan A, Ulukent SC, et al. A randomized prospective study of complications between general surgery residents and attending surgeons in near-total thyroidectomies. Surg Today 2004;34:997–1001

    Article  PubMed  Google Scholar 

  48. Udelsman R. Experience counts. Ann Surg 2004;26–27

  49. Yarbrough DE, Thompson GB, Kasperbauer JL, et al. Intraoperative electromyographic monitoring of the recurrent laryngeal nerve in reoperative thyroid and parathyroid surgery. Surgery 2004;136:1107–1115

    Article  PubMed  Google Scholar 

  50. Chan WF, Lo CY, Lam KY, et al. Recurrent laryngeal nerve palsy in well-differentiated thyroid carcinoma: clinicopathologic features and outcome study. World J Surg 2004;28:1093–1098

    Article  PubMed  Google Scholar 

  51. Sinagra DL, Montesinos MR, Tacchi VA, et al. Voice changes after thyroidectomy without recurrent laryngeal nerve injury. J Am Coll Surg 2004;199:556–560

    Article  PubMed  Google Scholar 

  52. Kohn KT, Corrigan JM, Donaldson MS. To err is human: Building a safer health system. Washington, DC, National Academy Press, 1999

    Google Scholar 

  53. Leape LL, Berwick DM. Five years after To err is human: what have we learned? JAMA 2005;293:2384–2390

    Article  CAS  PubMed  Google Scholar 

  54. Miccoli P, Berti P, Raffaelli M, et al. Comparison between minimally invasive video-assisted thyroidectomy and conventional thyroidectomy: a prospective randomized study. Surgery 2001;130:1039–1043

    Article  CAS  PubMed  Google Scholar 

  55. Ikeda Y, Takami H, Sasaki Y, et al. Are there significant benefits of minimally invasive endoscopic thyroidectomy? World J Surg 2004;28:1075–1078

    Article  PubMed  Google Scholar 

  56. Sackett WR, Barraclough BH, Sidhu S, et al. Minimal access thyroid surgery: is it feasible, is it appropriate? ANZ J Surg 2002;72:777–780

    Article  PubMed  Google Scholar 

  57. Bellantone R, Lombardi CP, Raffaelli M, et al. Is routine supplementation therapy (calcium and vitamin D) useful after total thyroidectomy? Surgery 2002;132:1109–1112

    Article  PubMed  Google Scholar 

  58. Ikeda Y, Takami H, Sasaki Y, et al. Comparative study of thyroidectomies. Endoscopic surgery versus conventional open surgery. Surg Endosc 2002;16:1741–1745

    Article  CAS  PubMed  Google Scholar 

  59. Seven H, Calis AB, Vural C, et al. Microscopic thyroidectomy: a prospective controlled trial. Eur Arch Otorhinolaryngol 2005;262:41–44

    Article  PubMed  Google Scholar 

  60. Testini M, Nacchiero M, Miniello S, et al. One-day vs standard thyroidectomy. A perspective study of feasibility. Minerva Endocrinol 2002;29:225–229

    Google Scholar 

  61. Sahai A, Symes A, Jeddy T. Short-stay thyroid surgery. Br J Surg 2005;92:58–59

    Article  CAS  PubMed  Google Scholar 

  62. Moore FD Jr. Oral calcium supplements to enhance early hospital discharge after bilateral surgical treatment of the thyroid gland or exploration of the parathyroid glands. J Am Coll Surg 1994;178:11–16

    PubMed  Google Scholar 

  63. Park GR, Drummond GB, Sinclair IS, et al. Bupivacaine infiltration for thyroid surgery. J R Coll Surg Edinb 1983;28:295–296

    CAS  PubMed  Google Scholar 

  64. Aunac S, Carlier M, Singelyn F, et al. The analgesic efficacy of bilateral combined superficial and deep cervical plexus block administered before thyroid surgery under general anesthesia. Anesth Analg 2002;95:746–750

    Article  CAS  PubMed  Google Scholar 

  65. Sonner JM, Hynson JM, Clark O, et al. Nausea and vomiting following thyroid and parathyroid surgery. J Clin Anesth 1997;9:398–402

    Article  CAS  PubMed  Google Scholar 

  66. Burkey SH, Van Heerden JA, Thompson GB, et al. Reexploration for symptomatic hematomas after cervical exploration. Surgery 2001;130:914–920

    Article  CAS  PubMed  Google Scholar 

  67. Lacoste L, Gineste D, Karayan J, et al. Airway complications in thyroid surgery. Ann Otol Rhinol Laryngol 1993;102:441–446

    CAS  PubMed  Google Scholar 

  68. Abbas G, Dubner S, Heller KS. Re-operation for bleeding after thyroidectomy and parathyroidectomy. Head Neck 2001;23:544–546

    Article  CAS  PubMed  Google Scholar 

  69. Shaha AR, Jaffe BM. Practical management of post-thyroidectomy hematoma. J Surg Oncol 1994;57:235–238

    CAS  PubMed  Google Scholar 

  70. Hurtado-Lopez LM, Zaldivar-Ramirez FR, Basurto KE, et al. Causes for early reintervention after thyroidectomy. Med Sci Monit 2002;8:CR247–CR250

    PubMed  Google Scholar 

  71. Bergamaschi R, Becouarn G, Ronceray J, et al. Morbidity of thyroid surgery. Am J Surg 1998;176:71–75

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

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.

Author information

Authors and Affiliations

  1. Division of General Surgery, The New York Thyroid Center, College of Physicians and Surgeons, Columbia University, 177 Fort Washington Avenue, MHB-7SK, New York, NY, 10032, USA

    Kathryn Spanknebel MD, John A. Chabot MD, Mary DiGiorgi MS, James Curty, John Allendorf MD & Paul LoGerfo MD

  2. Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA

    Kenneth Cheung PhD

Authors
  1. Kathryn Spanknebel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John A. Chabot MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mary DiGiorgi MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kenneth Cheung PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. James Curty
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. John Allendorf MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paul LoGerfo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kathryn Spanknebel MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Spanknebel, K., Chabot, J.A., DiGiorgi, M. et al. Thyroidectomy Using Monitored Local or Conventional General Anesthesia: An Analysis of Outpatient Surgery, Outcome and Cost in 1,194 Consecutive Cases. World J. Surg. 30, 813–824 (2006). https://doi.org/10.1007/s00268-005-0384-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-005-0384-3

Keywords

Search

Navigation