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Ambulante und kurzzeitstationäre Schilddrüsen- und Nebenschilddrüsenchirurgie

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Zusammenfassung

Ambulante und kurzzeitstationäre Schilddrüsen- und Nebenschilddrüsenoperationen sind in Deutschland bislang nicht üblich. Obwohl ein beträchtlicher Teil dieser Operationen mit niedriger Morbidität, nahezu Nullletalität und kurzer Operationsdauer durchgeführt werden können, spricht vor allem das Vorkommen potenziell letaler Komplikationen, insbesondere Nachblutungen, gegen eine großzügige Verkürzung der stationären Behandlungsdauer. Symptomatische Nachblutungen werden in etwa 1–2% beobachtet. Sie treten häufig (ca. 40%) in den ersten 8 postoperativen Stunden auf, mehrheitlich jedoch später (ca. 60%) und sogar nach 24 h (ca. 20%) noch manifest werden. Ein ambulantes Behandlungskonzept ist daher nicht empfehlenswert. Die kurzzeitstationäre (<23 h, über Nacht) Behandlung kann dagegen ein attraktives Konzept sein, wenn die Voraussetzungen hinsichtlich klar definierter Entlassungskriterien und professioneller ambulanter Nachsorgestrukturen gegeben sind. Zur Verkürzung der postoperativen Behandlungsdauer bieten lokale und regionale Anästhesieverfahren gegenüber der Allgemeinnarkose keinen Vorteil. Auch eine prophylaktische Kalziumsubstitution nach bilateralen Schilddrüsen- und Nebenschilddrüsenoperationen wird zur Verkürzung der Behandlungsdauer nicht empfohlen.

Abstract

Outpatient or short-stay thyroid and parathyroid surgery is still uncommon in Germany. Although a substantial number of these operations are performed with low morbidity, nearly zero mortality, and short operation time, some potentially lethal complications, especially postoperative hemorrhage, are strong arguments against liberal shortening of hospital stay. Symptomatic hematomas after thyroid and parathyroid surgery are observed in about 1-2% of cases. They frequently occur during the first 8 h after operation (40%). However, two thirds of these major complications occur later, about 20% of them more than 24 h postoperatively. Therefore, an outpatient procedure cannot be generally recommended. Short-stay (<23 h, overnight) thyroid and parathyroid surgery may be attractive, but this concept requires clear release-criteria and professional outpatient structures. Compared to general anesthesia, local and regional anesthesia did not emerge as helpful to shorten hospital stay. Also, prophylactic calcium supplementation is not recommended to enhance early hospital discharge after bilateral thyroid or parathyroid surgery.

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  1. Klinik für Allgemein-,Viszeral- und Gefäßchirurgie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)

    H. Dralle, C. Sekulla, K. Lorenz & B. Irmscher

  2. Klinik für Anästhesiologie und Intensivmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)

    St. Grond

  3. Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Martin-Luther-Universität Halle-Wittenberg, Klinikum Kröllwitz, Ernst-Grube-Straße 40, 06097, Halle (Saale)

    H. Dralle

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Dralle, H., Sekulla, C., Lorenz, K. et al. Ambulante und kurzzeitstationäre Schilddrüsen- und Nebenschilddrüsenchirurgie. Chirurg 75, 131–143 (2004). https://doi.org/10.1007/s00104-003-0775-7

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