Thyroidectomy in a community hospital: findings of 100 consecutive cases.

The objective of this study was to determine the characteristics and surgical outcomes of 100 consecutive cases of thyroidectomy (in 98 patients) at a community hospital from October 2005 to mid-November 2006. Preoperative laryngoscopy was performed in 94% of patients and postoperative laryngoscopy in 100%. Patients' thyroid nodules had been found incidentally in 28% of cases. The two most common indications for surgery were results of fine-needle aspiration biopsy (FNA) in 55% and size of the thyroid in 22% of cases. Of the 98 patients, 79 (81%) had benign diagnoses, 7 (7%) had microcarcinomas, and 12 (12%) had well-differentiated thyroid cancer. Overall, 5 patients (5%) had temporary recurrent laryngeal nerve paralysis, but this occurred in only 1 (1%) patient in the group with smaller lesions, a statistically significant difference (p< 0.02); none had permanent paralysis. Of 36 patients at risk for hypocalcemia, 3 (8%) and 1 (3%) had temporary and long-term hypocalcemia, respectively. There was no incidence of significant hemorrhage. FNA results were very accurate. We show that thyroidectomy can be performed with minimal laryngeal nerve paralysis or other complications. Larger lesions had significantly higher rates of temporary laryngeal nerve paralysis.

The case for an outpatient "approach" for all pediatric tonsillectomies and/or adenoidectomies: a 4-year review of 1419 cases at a community hospital.

OBJECTIVE: We sought to document the safety and efficacy of approaching all pediatric tonsillectomies and/or adenoidectomies (T/A) as outpatient procedures. STUDY DESIGN AND SETTING: We conducted a 4-year retrospective study of 1419 pediatric patients undergoing T/A at an outpatient center with procedures performed by a single group of surgeons. RESULTS: None of the 593 patients undergoing an adenoidectomy and only 5 (0.6%) of those having a tonsillectomy had significant bleeding postoperatively. There were no readmissions for airway problems. Children younger than age 3 were most likely to have complications and to be held for overnight observations. CONCLUSIONS: Most children can be safely discharged after T/A. The higher incidence of perioperative complications in children who are younger than 3 years of age paralleled their higher rate of overnight observation. SIGNIFICANCE: Children less than 3 years of age require more careful observation, especially after tonsillectomy and more likely will need to be observed overnight than older children.