Abstract
Background
Current studies and guidelines have reported that outpatient endocrine surgery is
safe. However, none recommend specific postoperative protocols.
Methods
An internet-based survey, developed using expert input, was distributed to current
(2021–2022) endocrine surgery fellows in American Association of Endocrine Surgeons–accredited
programs (n = 23). Programs with ≤2% same-day discharge rate were compared with those with ≥2%
same-day discharge rate.
Results
The survey response rate was 91% (21/23), representing 20 United States institutions
performing >15,000 cervical endocrine operations annually. The same-day discharge
rate after total thyroidectomy was not normally distributed across institutions (P < .0001) but appeared bimodal, highlighting dogmatic differences in the pursuit of
same-day discharge. Nine programs had ≤2% same-day discharge rate, whereas seven had
≥90% same-day discharge rate. Fourteen (70%) reported minimum observation periods
before discharge, without consistency across procedures or institutions. Total thyroidectomy
patients were observed longer. Fourteen (70%) reported no geographic restrictions
for same-day discharge. In programs with >2% same-day discharge (n = 11), clinical and operative factors inconsistently influenced same-day discharge
after thyroidectomy. Living alone precluded same-day discharge in 3 programs. Lateral
neck dissection and chronic anticoagulation each greatly reduced same-day discharge
in one program and precluded same-day discharge in another. Central neck dissection,
Graves’ disease, substernal goiter, continuous positive airway pressure use, difficult/bloody
operation, and signal on nerve stimulation had no or minimal effect on same-day discharge.
Postoperative medication recommendations varied among programs. Although anticoagulation/antiplatelet
agents were similarly held preoperatively across programs, resumption varied. Narcotics
were routinely prescribed in 35%.
Conclusion
Same-day discharge is not uniform across endocrine surgery training programs and is
likely primarily driven by surgeon preference. Factors influencing same-day discharge
vary significantly among programs.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Postoperative outcomes in Graves’ disease patients: results from the nationwide inpatient sample database.Thyroid. 2017; 27: 825-831
- The maturation of a specialty: workforce projections for endocrine surgery.Surgery. 2007; 142: 876-883
- Epidemiological and economic trends in inpatient and outpatient thyroidectomy in the United States, 1996-2006.Thyroid. 2013; 23: 727-733
- Safety of outpatient thyroidectomy: review of the American College of Surgeons National Surgical Quality Improvement Program.Laryngoscope. 2018; 12: 1249-1254
- Safety of same-day thyroidectomy: meta-analysis and systematic review.Gland Surg. 2017; 6: 292-301
- Safety and cost-effectiveness of outpatient thyroidectomy: a retrospective observational study.Saudi Med J. 2021; 42: 188-195
- Ambulatory surgery vs overnight observation for total thyroidectomy: cost analysis and outcomes.OTO Open. 2021; 52473974X21995104
- Outpatient thyroid surgery is safe and desirable.Otolaryngol Head Neck Surg. 2007; 136: 556-559
- Reexploration for symptomatic hematomas after cervical exploration.Surgery. 2001; 130: 914-920
- Post-thyroidectomy hemorrhage: a national study of patients treated at the Danish departments of ENT head and neck surgery.Eur Arch Oto-Rhino-Laryngology. 2009; 266: 1945-1952
- Local anesthesia with monitored anesthesia care vs general anesthesia in thyroidectomy: a randomized study.Arch Surg. 2006; 141: 167-173
- Outpatient thyroidectomy: experience in over 200 patients.Laryngoscope. 2010; 120: 959-963
- Life-threatening neck hematoma complicating thyroid and parathyroid surgery.Am J Surg. 2008; 195: 339-343
- American Thyroid Association statement on outpatient thyroidectomy.Thyroid. 2013; 23: 1193-1202
- Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009; 42: 377-381
- The REDCap consortium: building an international community of software platform partners.J Biomed Inform. 2019; 95103208
United States Census Bureau. 2010 Census Regions and Divisions of the United States.
- Narcotic free cervical endocrine surgery: a shift in paradigm.Ann Surg. 2021; 274: e143-e149
- Questionable safety of thyroid surgery with same day discharge.Ann R Coll Surg Engl. 2012; 94: 543-547
- Prevention, evaluation, and management of complications following thyroidectomy for thyroid carcinoma.Endocrinol Metab Clin North Am. 2003; 32: 483-502
- Risk factors for neck hematoma requiring surgical re-intervention after thyroidectomy: a systematic review and meta-analysis.BMC Surg. 2019; 19: 1-12
- Outpatient thyroidectomy: is it safe?.Surg Oncol Clin N Am. 2016; 25: 61-75
- Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany.World J Surg. 2000; 24: 1335-1341
- Does the risk of compressive hematoma after thyroidectomy authorize 1-day surgery?.Langenbecks Arch Surg. 2008; 393: 733-737
- Risk factors for postoperative bleeding after thyroid surgery.Br J Surg. 2012; 99: 373-379
- Factors associated with neck hematoma after thyroidectomy a retrospective analysis using a Japanese inpatient database.Medicine. 2016; 95e2812
- A review of risk factors and timing for postoperative hematoma after thyroidectomy: is outpatient thyroidectomy really safe?.World J Surg. 2012; 36: 2497-2502
- A multi-institutional international study of risk factors for hematoma after thyroidectomy.Surgery. 2013; 154: 1283-1291
- Outpatient thyroid surgery: should patients be discharged on the day of their procedures?.Can J Surg. 2009; 52: 182
- How to perform a thyroidectomy in an outpatient setting.Langenbecks Arch Surg. 2009; 394: 897-902
- Safety of same day discharge in patients undergoing sutureless thyroidectomy: a comparison of local and general anesthesia.Thyroid. 2008; 18: 57-61
- Outpatient thyroid surgery in a Toronto community hospital.J Otolaryngol Head Neck Surg. 2011; 40: 458-461
- outpatient thyroidectomy is safe and reasonable: experience with more than 1,000 planned outpatient procedures.J Am Coll Surg. 2010; 210: 575-582
- Same-day thyroidectomy program: eligibility and safety evaluation.Surgery. 2012; 152: 1133-1141
- Outpatient thyroidectomy: safety and patients’ satisfaction.J Otolaryngol Head Neck Surg. 2012; 41: S1-S12
- Outpatient thyroid surgery: safety of an optimized protocol in more than 1,000 patients.Surgery. 2016; 159: 518-523
- Patterns of antibiotic prophylaxis use for thyroidectomy and parathyroidectomy: results of an international survey of endocrine surgeons.J Am Coll Surg. 2010; 210: 949-956
Article info
Publication history
Published online: September 30, 2022
Accepted:
May 3,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
