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Thyroidectomy is generally considered a low-to-moderate risk operation; however, postoperative pain, nausea/vomiting, and prolonged hospital stays remain common issues. Enhanced Recovery After Surgery (ERAS) pathways aim to optimize perioperative care and accelerate recovery. This study evaluates the effectiveness and safety of a standardized ERAS pathway in patients undergoing elective thyroidectomy. The prospective ERAS cohort is compared with a historical control group receiving conventional care to assess the impact on the length of hospital stay, postoperative pain, opioid consumption, and complication rates.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ERAS group | A prospective cohort undergoing elective thyroidectomy under an ERAS protocol. |
| |
| Control group | A historical control cohort undergoing thyroidectomy under conventional care during the 12 months preceding ERAS implementation |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Enhanced Recovery After Surgery protocol | Procedure | This incorporates standardized preoperative counseling, reduced fasting, multimodal opioid-sparing analgesia, total intravenous anesthesia, selective drain use, early oral intake and mobilization, and PTH-guided calcium supplementation |
| Measure | Description | Time Frame |
|---|---|---|
| Length of hospital stay | Hours from surgery end to discharge | Up to 30 days post-surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative pain scores | Mean Numeric Rating Scale (NRS-11; 0 = no pain to 10 = worst imaginable pain) at rest in 24 hours. NRS scores are categorized as mild (1-3), moderate (4-6), or severe (7-10). | Assessed in the first 24 hours postoperatively |
| Total opioid consumption |
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Inclusion Criteria:
Exclusion Criteria:
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Patients scheduled for elective thyroidectomy for benign or malignant disease at a tertiary cancer institute
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Surgical Oncology Department, South Egypt Cancer Institute, Assiut University | Asyut | Asyut Governorate | 71516 | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38888927 | Background | Althans AR, Holder-Murray J, Tessler RA. The Future of Enhanced Recovery After Surgery-Precision vs Protocol. JAMA Netw Open. 2024 Jun 3;7(6):e2418968. doi: 10.1001/jamanetworkopen.2024.18968. No abstract available. | |
| 38888922 | Background | Sauro KM, Smith C, Ibadin S, Thomas A, Ganshorn H, Bakunda L, Bajgain B, Bisch SP, Nelson G. Enhanced Recovery After Surgery Guidelines and Hospital Length of Stay, Readmission, Complications, and Mortality: A Meta-Analysis of Randomized Clinical Trials. JAMA Netw Open. 2024 Jun 3;7(6):e2417310. doi: 10.1001/jamanetworkopen.2024.17310. |
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| ID | Term |
|---|---|
| D013959 | Thyroid Diseases |
| D006042 | Goiter |
| D013964 | Thyroid Neoplasms |
| ID | Term |
|---|---|
| D004700 | Endocrine System Diseases |
| D004701 | Endocrine Gland Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
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|
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| Conventional perioperative care | Procedure | This often involves prolonged preoperative fasting, opioid-based analgesia, and delayed mobilization |
|
Oral Morphine Milligram Equivalents (MME) |
| Within first 24 hours |
| Postoperative nausea and vomiting (PONV) | Incidence of PONV | Up to 24 hours postoperatively |
| Rate of postoperative hypocalcemia | Biochemical and symptomatic occurrences | First 30 days from the surgery |
| 30-day unplanned readmission rate | Number of unplanned readmissions | Up to 30 days postoperative |
| 30833861 | Background | Simpson JC, Bao X, Agarwala A. Pain Management in Enhanced Recovery after Surgery (ERAS) Protocols. Clin Colon Rectal Surg. 2019 Mar;32(2):121-128. doi: 10.1055/s-0038-1676477. Epub 2019 Feb 28. |
| 37973430 | Background | Machado N, Mortlock R, Maduka R, Souza Cunha AE, Dyer E, Long A, Canner JK, Tanella A, Gibson C, Hyman J, Ogilvie J. Early observations with an ERAS pathway for thyroid and parathyroid surgery: Moving the goalposts forward. Surgery. 2024 Jan;175(1):114-120. doi: 10.1016/j.surg.2023.06.052. Epub 2023 Nov 15. |
| 29120517 | Background | Lee DJ, Chin CJ, Hong CJ, Perera S, Witterick IJ. Outpatient versus inpatient thyroidectomy: A systematic review and meta-analysis. Head Neck. 2018 Jan;40(1):192-202. doi: 10.1002/hed.24934. Epub 2017 Nov 9. |
| D006258 |
| Head and Neck Neoplasms |