Outpatient (Same-day Discharge) versus Inpatient Parotidectomy: A Systematic Review and Meta-analysis

There has been a shift towards shorter hospital stays and greater efficiency to reduce overall cost and increase economic benefit. Parotidectomy has traditionally been an inpatient procedure due to drain insertion; however, outpatient parotidectomy has recently become an attractive alternative.

Here, studies were identified that compared the safety of outpatient parotidectomy to that of inpatient (at least overnight stay) parotidectomy. Primary outcome was to compare complication rates. Secondary outcomes were to assess the re-admission rate.

A systematic literature search was performed on different electronic databases from 01/01/1990 to 05/10/2019.Abstract review of all articles, full article revision of included studies, data extraction and quality assessment was performed by four independent assessors.

445 studies were identified. Six articles were selected for inclusion in the systematic review, five of which were included into the meta-analysis. All articles reported outpatient parotidectomy and inpatient parotidectomy and used retrospective observational designs, representing moderate-level evidence.

A total of 3664 patients were included (1646 in the outpatient group and 2018 in the inpatient group). Comparing the outpatient to inpatient cohorts, there were lower complications in outpatient groups though not statistically significant for haematoma (OR= 0.45; 95 % CI= 0.11-1.92; p = 0.28), surgical site infection (OR = 0.88; 95 % CI = 0.46-1.69; p = 0.70), seroma (0.79; 95 % CI = 0.21-3.03; p = 0.74), facial nerve weakness (OR 0.39; 95 % CI = 0.14-1.08; p = 0.07) and hospital readmission (OR 0.58; 95 % CI = 0.33-1.04; p = 0.07).

Outpatient parotidectomy appears to be safe with comparable peri- and post-operative complication rates as compared to inpatient procedures.

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Publication History

Article published online:
10 June 2020