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This systematic review and meta-analysis discusses the safety of hemithyroidectomy in an outpatient vis-à-vis an inpatient setting. Thyroidectomy has traditionally been performed as an inpatient procedure. Currently, an increasing number of surgeons are performing thyroidectomy in outpatient settings. The main concern after thyroidectomy is post-thyroidectomy bleeding (PTB) and hematoma formation with airway compromise, followed by nerve damage and infection. This study found a low risk of PTB irrespective of whether the surgery was performed in an inpatient or outpatient setting (1.1% incidence of PTB in the inpatient versus 0.6% in the outpatient group). The authors admit that there was a high risk of bias as patients with low risk of bleeding were selected for outpatient thyroidectomy and most studies included in the cohort were categorised as poor quality by the NOS (Newcastle Ottawa) scale for cohort studies. In practice, the American Thyroid Association guidelines help to plan the setting for thyroid surgery as the guidelines are based on absence of comorbidities (for example, bleeding disorders and anticoagulant therapy), preoperative patient education, access to primary care, and proximity to skilled facility.

Risk of hematoma after hemithyroidectomy in an outpatient setting: a systematic review and meta-analysis.
Jeppesen K, Moos C, Holm T, et al.
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Gauri Mankekar

Department of Otolaryngology-Head Neck Surgery, Louisiana State University Shreveport, Louisiana, USA.

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