AIM: The Coronavirus disease 19 (COVID-19) pandemic has significantly impacted elective thyroid surgery, leading to a reduction in procedures and an increase in waiting lists. In response, thyroidectomy is increasingly being performed as an outpatient procedure worldwide, with comparable outcomes and readmission rates to those of overnight stays after surgery in high-volume centers. However, in Italy, ambulatory thyroid surgery is rarely practiced because of concerns about the safety and efficacy of such approaches. This specific timeframe represents a unique opportunity to capture a snapshot of the Italian thyroid surgery practices and drive a practice change while providing a practical solution to the huge backlog of procedures. METHODS: A survey was conducted among Italian surgical centers to assess their practices and preferences regarding various aspects of thyroid surgery, including preoperative assessment, intraoperative techniques, and postoperative care. The survey also explored the use of minimally invasive approaches and the adoption of day surgery or overnight stay procedures. Data were collected through a structured questionnaire. The survey data were analyzed using descriptive statistics and clustering techniques to identify patterns and groupings among surgeons on the basis of their responses. RESULTS: A variety of practices have emerged among surgeons performing thyroid surgery, with varying preferences for hemostatic methods, additional hemostasis techniques, and the use of drains. A significant proportion of surgeons (47%) still favor traditional inpatient stays for thyroid surgery, whereas others offer day surgery or overnight stays for selected cases (53%). The use of intraoperative nerve monitoring is widespread (73%), but the choice of monitoring methods and the factors influencing its use vary among surgeons. Only 21% of surgeons rely solely on traditional suture ligations for hemostasis, whereas 41% routinely use hemostatic absorbable gauze for additional hemostasis. Minimally invasive approaches, such as Minimally Invasive Video-Assisted Thyroidectomy (MIVAT) (23%) and robotic surgery (7%), are also utilized. Day surgery is offered only in academic hospitals and endocrine surgery referral centers. CONCLUSIONS: Significant variation exists in thyroid surgery practices, emphasizing the need for further research and standardized protocols, particularly in areas such as preoperative assessment, hemostasis techniques, and postoperative care. By establishing best practices, surgeons can confidently expand the offering of day-surgery and one-day surgery options, leading to shorter waiting lists and improved patient care. This shift toward more efficient and patient-centered approaches requires collaborative efforts among surgeons and hospitals to ensure safety and optimal outcomes for patients undergoing thyroid surgery.
Current Practices and Perspectives on Ambulatory Thyroid Surgery in Italy: A Survey by the Società Italiana Chirurgia Endoscopica e Nuove Tecnologie (SICE) in Preparation for the DECORATED Trial
Curro', Giuseppe
2025-01-01
Abstract
AIM: The Coronavirus disease 19 (COVID-19) pandemic has significantly impacted elective thyroid surgery, leading to a reduction in procedures and an increase in waiting lists. In response, thyroidectomy is increasingly being performed as an outpatient procedure worldwide, with comparable outcomes and readmission rates to those of overnight stays after surgery in high-volume centers. However, in Italy, ambulatory thyroid surgery is rarely practiced because of concerns about the safety and efficacy of such approaches. This specific timeframe represents a unique opportunity to capture a snapshot of the Italian thyroid surgery practices and drive a practice change while providing a practical solution to the huge backlog of procedures. METHODS: A survey was conducted among Italian surgical centers to assess their practices and preferences regarding various aspects of thyroid surgery, including preoperative assessment, intraoperative techniques, and postoperative care. The survey also explored the use of minimally invasive approaches and the adoption of day surgery or overnight stay procedures. Data were collected through a structured questionnaire. The survey data were analyzed using descriptive statistics and clustering techniques to identify patterns and groupings among surgeons on the basis of their responses. RESULTS: A variety of practices have emerged among surgeons performing thyroid surgery, with varying preferences for hemostatic methods, additional hemostasis techniques, and the use of drains. A significant proportion of surgeons (47%) still favor traditional inpatient stays for thyroid surgery, whereas others offer day surgery or overnight stays for selected cases (53%). The use of intraoperative nerve monitoring is widespread (73%), but the choice of monitoring methods and the factors influencing its use vary among surgeons. Only 21% of surgeons rely solely on traditional suture ligations for hemostasis, whereas 41% routinely use hemostatic absorbable gauze for additional hemostasis. Minimally invasive approaches, such as Minimally Invasive Video-Assisted Thyroidectomy (MIVAT) (23%) and robotic surgery (7%), are also utilized. Day surgery is offered only in academic hospitals and endocrine surgery referral centers. CONCLUSIONS: Significant variation exists in thyroid surgery practices, emphasizing the need for further research and standardized protocols, particularly in areas such as preoperative assessment, hemostasis techniques, and postoperative care. By establishing best practices, surgeons can confidently expand the offering of day-surgery and one-day surgery options, leading to shorter waiting lists and improved patient care. This shift toward more efficient and patient-centered approaches requires collaborative efforts among surgeons and hospitals to ensure safety and optimal outcomes for patients undergoing thyroid surgery.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
