Objective: To explore the feasibility and safety of ambulatory thyroid surgery under the protocol of enhanced recovery after surgery (ERAS).
Methods: The clinical data of 1 023 patients who underwent thyroid surgery under strict selection criteria in the ambulatory ward of Xiangya Hospital of Central South University between January 2015 and August 2018 were retrospectively analyzed. The ERAS protocol was implemented in all patients before, during and after surgery.
Results: Of the 1 023 patients, 806 cases (78.8%) were females and 217 cases (21.2%) were males, with a mean age of (40±10) years; 275 cases (26.9%) underwent endoscopic surgery and 748 cases (73.1%) had open surgery. The average operative time was (114.32±38.41) min, the average hospitalization time was (20.6±6.9) h, and the average intraoperative blood loss was (26.62±31.31) mL. Wound swelling and neck compression symptoms occurred in one patient undergoing bilateral areolar endoscopy 4 h after operation due to bleeding from the chest subcutaneous tunnel, which were improved by aspiration drainage and local compression. Transient hypocalcemia and symptomatic hypocalcemia occurred in 335 cases (32.7%) and 123 (12.0%) after operation, and the incidence of hypocalcemia and symptomatic hypocalcemia for endoscopic surgery was 29.45% and 8.73%, and for open surgery was 33.96% and 13.23%, respectively. Temporary recurrent laryngeal nerve injury was found in 28 cases (2.7%) (including 7 cases undergoing endoscopic surgery and 21 cases undergoing open surgery). No permanent hypocalcemia or recurrent laryngeal nerve injury was noted in any of the patients after operation. Postoperative wound infection occurred in 2 patients (0.73%) undergoing endoscopic surgery and one patient (0.13%) undergoing open surgery, respectively. No cases of postoperative esophageal leakage, trachea leakage, chylous leakage, dyspnea and asphyxia were observed in these patients.
Conclusion: Under strict selection criteria, and ERAS concept guidance for whole treatment process, ambulatory thyroid surgery is a safe and feasible, as well as convenient and efficient surgical approach.