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.