Barriers to Same-Day Discharge of Patients Undergoing Total and Completion Thyroidectomy

Abstract

Objective Describe barriers to same-day surgery for patients undergoing total and completion thyroidectomy. Study Design Case series with chart review. Setting Academic health sciences center. Subjects and Methods The subjects were patients who underwent total thyroidectomy or completion thyroidectomy and remained in hospital overnight or longer. A review was performed on patients who were operated on by a single surgeon from July 2005 through June 2013. Results Two hundred and sixty-eight cases were planned for same-day surgery. One hundred patients were not discharged on the same day (37%). Patients observed overnight or admitted to hospital had significantly lower postoperative calcium levels, 8.4 mg/dL ( P < .0001), and lower intraoperative parathyroid hormone (PTH), mean 6.0 pg/mL ( P < .0001). Those significantly more likely to require overnight observation were male patients ( P = .0117), black patients ( P = .0045), those with completion thyroidectomy ( P = .0039), and those with a complication of surgery ( P = .003). Conclusion Intraoperative PTH less than 10 pg/mL was the most frequent factor (25.7%) precluding same-day discharge, followed by admission for social/financial/transportation reasons (22.6%), large dead space from goiter (15.5%), multiple comorbidities (13.4%), multiple surgical reasons (5.2%), airway observation (5.2%), pain management (3.1%), and intractable nausea due to general anesthetic (2.1%). Hypocalcemia and postoperative bleeding still remain obstacles to outpatient thyroid surgery; however, the use of rapid PTH testing, modern hemostatic techniques, appropriate calcium prophylaxis, and experienced clinical decision making can effectively stratify which patients require overnight observation.