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.