Update Course Rewind: Who to Send Home from the OR #4 Part 2: Partial Thyroidectomy

Stay Current in Pediatric Surgery

We are back with another Update Course Rewind video from the Update Course in Pediatric Surgery 2023.

This time we are presenting you "Who to Send Home from the OR: Partial Thyroidectomy" with Drs. Mark Wulkan, Justin Huntington, Tolulope Oyetunji, & Phillip Ben Ham.

Host: Cecilia Gigena

This video explores the considerations for same day discharge following minimally invasive pectus excavatum repair with intercostal neuro-cryoablation and uncomplicated right thyroid lobectomy. Key Points:

• Pectus Excavatum Repair:

• Discharge Timing: The majority of surgeons prefer a post-op stay of 2-3 days, but up to 20% consider same day discharge. The effectiveness of cryoablation and intercostal nerve blocks plays a significant role in determining discharge timing.
• ERAS Protocol Impact: Combining cryoablation with an Enhanced Recovery After Surgery (ERAS) protocol has shown a reduction in opioid use and length of hospital stay, with many patients able to go home by day two.
• Patient and Family Education: Setting expectations about post-op pain and recovery is crucial for successful same day or early discharge.

• Thyroid Lobectomy:

• Same Day Discharge Feasibility: Approximately 30% of surgeons discharge patients on the same day, with the rest keeping them overnight due to concerns about post-op bleeding and recurrent laryngeal nerve injury.
• ATA Guidelines: The American Thyroid Association supports same day discharge for suitable patients, considering clinical, social, and procedural factors.
• Complication Management: While the risk of post-op hematoma exists, newer technologies and careful monitoring have reduced its occurrence, making same day discharge more viable.

Summary:

• Pectus Excavatum Repair: Same day discharge is possible with cryoablation and ERAS, though most patients are discharged on day two or three based on pain control and patient preference.
• Thyroid Lobectomy: Same day discharge is increasingly accepted, particularly with newer surgical techniques and careful patient selection, but overnight observation remains common due to the risk of complications like post-op bleeding.