Key Findings
Our study demonstrates that the majority of patients were satisfied with
the drainless outpatient parotidectomy and preferred a drainless
procedure over inpatient parotidectomy with surgical drains. Patients at
our centre also expressed satisfaction with the service provided at the
preadmission visit, admission on the ward, operating room experience,
nursing care, medical care, information received and autonomy in making
decisions regarding their care.
Previous systematic reviews have reported that outpatient parotidectomy
is safe and feasible with comparable complication rates and readmission
rates to inpatient parotidectomy (10). Using our own case series, we
explored our patients’ experience on the day case procedure and our
findings suggest that patients are highly satisfied with their overall
experience. With inpatient and outpatient parotidectomy having
comparable clinical outcomes, patient satisfaction gives outpatient
drainless parotidectomy an added edge to provide an overall benefit over
inpatient parotidectomy. A study by Bentkover et al. in 1996 reported
that outpatient satisfaction was high but inpatient satisfaction was
higher (13). Similarly, Cheng et al. reported a satisfaction rate of
84% (21 of 25) when patients were asked by surgeons during discharge
but the satisfaction on length of stay dropped to 56% (14 of 25) when
they were asked again by nurses 6 months later (17). However, both
studies had a surgical drain in place during discharge and caring for
drains at home increased patients’ anxiety. To date, no other studies
reported patient satisfaction on drainless outpatient parotidectomy.
Another key finding is that 16/28 (57.1%) of our patients either stayed
less than 23 hours or preferred an overnight stay in the hospital
despite having undergone drainless parotidectomy. Most patients were
admitted overnight either for social reasons, medical comorbidities or
anaesthesia recovery time. The remaining patients felt an overnight stay
would boost their confidence for discharge and reduce their overall
anxiety. Although same-day discharges are highly cost-effective for
healthcare institutions, patients’ preference for overnight hospital
stay needs to be taken into account when performing drainless
parotidectomies. In the future, efforts to promote same-day discharge
drainless parotidectomy (e.g. patient counselling, pre-operative
information packs, post-operative nursing inputs) can be increased to
reduce overnight stays in the hospital for non-surgical reasons.
A small proportion of patients also reported dissatisfaction on the
discharge and after care experience. Information on further treatment
and follow up care post-discharge were not conveyed appropriately to
this patient cohort. Some patients reported that their primary care
doctors were not aware of their outpatient parotidectomy procedure. It
is important to bear in mind that a multidisciplinary approach is
crucial for outpatient drainless parotidectomy and effective
communication between patient, surgeons, head and neck team and primary
care doctors should be emphasised in the future to ensure continuity of
care following discharge.
Lastly, a significant number of patients from our cohort reported issues
with the Balaclava pressure bandage (e.g. pain, itch, tightness and
discomfort). Although the compression Balaclava bandage facilitates
haemostasis control for drainless parotidectomy (19), patient comfort is
compromised and other bandage options can be explored in the future
without compromising haemostasis.