Outpatient parathyroid surgery and the differences seen in the morbidly obese

OBJECTIVE: This prospective study examined rapid patient discharge after routine parathyroidectomy to identify differences between morbidly obese and non-morbidly obese patients. The efficacy of supplemental calcium in preventing postoperative hypocalcemia was also assessed. METHODS: Between March 2003 and June 2004, 842 patients with primary hyperparathyroidism underwent outpatient parathyroid surgery. Morbid obesity was defined as 100 pounds above ideal body weight and/or body mass index greater than 39. RESULTS: Fifty-one (6.1%) patients were morbidly obese (mean, 261 lbs; body mass index = 45) compared with 791 non-morbidly obese patients (mean, 172 lbs; body mass index = 28, P <.001). Morbidly obese patients were more likely to require conversion of laryngeal masked airway to endotracheal intubation (P <.05). Incision length, total operative times, and the total time spent in the post-anesthesia care unit were longer for morbidly obese patients (all, P <.05). Of the 842 patients, only four, all non-morbidly obese, spent the night after their operation. No postoperative untoward events occurred in either group. CONCLUSIONS: Immediate discharge after routine parathyroid surgery is extremely safe for nearly all patients although morbid obesity is associated with a longer operation, a more difficult airway, and a longer stay in the recovery room. (C) 2007 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.