Outpatient endocrine surgery practice patterns are highly variable among US endocrine surgery fellowship programs

Published:September 30, 2022DOI:



      Current studies and guidelines have reported that outpatient endocrine surgery is safe. However, none recommend specific postoperative protocols.


      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.


      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%.


      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 access
      One-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 to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Rubio G.A.
        • Koru-Sengul T.
        • Vaghaiwalla T.M.
        • Parikh P.P.
        • Farra J.C.
        • Lew J.I.
        Postoperative outcomes in Graves’ disease patients: results from the nationwide inpatient sample database.
        Thyroid. 2017; 27: 825-831
        • Sosa J.A.
        • Wang T.S.
        • Yeo H.L.
        • et al.
        The maturation of a specialty: workforce projections for endocrine surgery.
        Surgery. 2007; 142: 876-883
        • Sun G.H.
        • Demonner S.
        • Davis M.M.
        Epidemiological and economic trends in inpatient and outpatient thyroidectomy in the United States, 1996-2006.
        Thyroid. 2013; 23: 727-733
        • McLaughlin E.J.
        • Brant J.A.
        • Bur A.M.
        • et al.
        Safety of outpatient thyroidectomy: review of the American College of Surgeons National Surgical Quality Improvement Program.
        Laryngoscope. 2018; 12: 1249-1254
        • Khadra H.
        • Mohamed S.
        • Hauch A.
        • Carter J.
        • Hu T.
        • Kandil E.
        Safety of same-day thyroidectomy: meta-analysis and systematic review.
        Gland Surg. 2017; 6: 292-301
        • AlEssa M.
        • Al-Angari S.S.
        • Jomah M.
        • et al.
        Safety and cost-effectiveness of outpatient thyroidectomy: a retrospective observational study.
        Saudi Med J. 2021; 42: 188-195
        • Rosen P.
        • Bailey L.
        • Manickavel S.
        • Gentile C.
        • Grayson J.
        • Buczek E.
        Ambulatory surgery vs overnight observation for total thyroidectomy: cost analysis and outcomes.
        OTO Open. 2021; 52473974X21995104
        • Terris D.J.
        • Moister B.
        • Seybt M.W.
        • Gourin C.G.
        • Chin E.
        Outpatient thyroid surgery is safe and desirable.
        Otolaryngol Head Neck Surg. 2007; 136: 556-559
        • Burkey S.H.
        • Van Heerden J.A.
        • Thompson G.B.
        • Grant C.S.
        • Schleck C.D.
        • Farley D.R.
        Reexploration for symptomatic hematomas after cervical exploration.
        Surgery. 2001; 130: 914-920
        • Godballe C.
        • Madsen A.R.
        • Pedersen H.B.
        • et al.
        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
        • Snyder S.K.
        • Roberson C.R.
        • Cummings C.C.
        • Rajab M.H.
        Local anesthesia with monitored anesthesia care vs general anesthesia in thyroidectomy: a randomized study.
        Arch Surg. 2006; 141: 167-173
        • Seybt M.W.
        • Terris D.J.
        Outpatient thyroidectomy: experience in over 200 patients.
        Laryngoscope. 2010; 120: 959-963
        • Rosenbaum M.A.
        • Haridas M.
        • McHenry C.R.
        Life-threatening neck hematoma complicating thyroid and parathyroid surgery.
        Am J Surg. 2008; 195: 339-343
        • Terris D.J.
        • Snyder S.
        • Carneiro-Pla D.
        • et al.
        American Thyroid Association statement on outpatient thyroidectomy.
        Thyroid. 2013; 23: 1193-1202
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        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
        • Harris P.A.
        • Taylor R.
        • Minor B.L.
        • et al.
        The REDCap consortium: building an international community of software platform partners.
        J Biomed Inform. 2019; 95103208
      1. United States Census Bureau. 2010 Census Regions and Divisions of the United States.

        • Ruffolo L.I.
        • Jackson K.M.
        • Juviler P.
        • et al.
        Narcotic free cervical endocrine surgery: a shift in paradigm.
        Ann Surg. 2021; 274: e143-e149
        • Doran H.E.
        • England J.
        • Palazzo F.
        Questionable safety of thyroid surgery with same day discharge.
        Ann R Coll Surg Engl. 2012; 94: 543-547
        • Zarnegar R.
        • Brunaud L.
        • Clark O.H.
        Prevention, evaluation, and management of complications following thyroidectomy for thyroid carcinoma.
        Endocrinol Metab Clin North Am. 2003; 32: 483-502
        • Fan C.
        • Zhou X.
        • Su G.
        • et al.
        Risk factors for neck hematoma requiring surgical re-intervention after thyroidectomy: a systematic review and meta-analysis.
        BMC Surg. 2019; 19: 1-12
        • Balentine C.J.
        • Sippel R.S.
        Outpatient thyroidectomy: is it safe?.
        Surg Oncol Clin N Am. 2016; 25: 61-75
        • Thomusch O.
        • Machens A.
        • Sekulla C.
        • et al.
        Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany.
        World J Surg. 2000; 24: 1335-1341
        • Leyre P.
        • Desurmont T.
        • Lacoste L.
        • et al.
        Does the risk of compressive hematoma after thyroidectomy authorize 1-day surgery?.
        Langenbecks Arch Surg. 2008; 393: 733-737
        • Promberger R.
        • Ott J.
        • Kober F.
        • et al.
        Risk factors for postoperative bleeding after thyroid surgery.
        Br J Surg. 2012; 99: 373-379
        • Suzuki S.
        • Yasunaga H.
        • Matsui H.
        • Fushimi K.
        • Saito Y.
        • Yamasoba T.
        Factors associated with neck hematoma after thyroidectomy a retrospective analysis using a Japanese inpatient database.
        Medicine. 2016; 95e2812
        • Lang B.H.H.
        • Yih P.C.L.
        • Lo C.Y.
        A review of risk factors and timing for postoperative hematoma after thyroidectomy: is outpatient thyroidectomy really safe?.
        World J Surg. 2012; 36: 2497-2502
        • Campbell M.J.
        • McCoy K.L.
        • Shen W.T.
        • et al.
        A multi-institutional international study of risk factors for hematoma after thyroidectomy.
        Surgery. 2013; 154: 1283-1291
        • Trottier D.C.
        • Barron P.
        • Moonje V.
        • Tadros S.
        Outpatient thyroid surgery: should patients be discharged on the day of their procedures?.
        Can J Surg. 2009; 52: 182
        • Champault A.
        • Vons C.
        • Zilberman S.
        • Labaille T.
        • Brosseau S.
        • Franco D.
        How to perform a thyroidectomy in an outpatient setting.
        Langenbecks Arch Surg. 2009; 394: 897-902
        • Inabnet W.B.
        • Shifrin A.
        • Ahmed L.
        • Sinha P.
        Safety of same day discharge in patients undergoing sutureless thyroidectomy: a comparison of local and general anesthesia.
        Thyroid. 2008; 18: 57-61
        • Sklar M.
        • Ali M.J.
        • Solomon P.
        Outpatient thyroid surgery in a Toronto community hospital.
        J Otolaryngol Head Neck Surg. 2011; 40: 458-461
        • Snyder S.K.
        • Hamid K.S.
        • Roberson C.R.
        • et al.
        outpatient thyroidectomy is safe and reasonable: experience with more than 1,000 planned outpatient procedures.
        J Am Coll Surg. 2010; 210: 575-582
        • Mazeh H.
        • Khan Q.
        • Schneider D.F.
        • Schaefer S.
        • Sippel R.S.
        • Chen H.
        Same-day thyroidectomy program: eligibility and safety evaluation.
        Surgery. 2012; 152: 1133-1141
        • Sahmkow S.I.
        • Audet N.
        • Nadeau S.
        • Camireá M.
        • Beaudoin D.
        Outpatient thyroidectomy: safety and patients’ satisfaction.
        J Otolaryngol Head Neck Surg. 2012; 41: S1-S12
        • Segel J.M.
        • Duke W.S.
        • White J.R.
        • Waller J.L.
        • Terris D.J.
        Outpatient thyroid surgery: safety of an optimized protocol in more than 1,000 patients.
        Surgery. 2016; 159: 518-523
        • Moalem J.
        • Ruan D.T.
        • Farkas R.L.
        • et al.
        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