Evaluation of total/near-total thyroidectomy in a short-stay hospitalization: safe and cost-effective.
BACKGROUND
Once the decision of perform total/near-total thyroidectomy has been made, common perioperative management strategies include frequent postoperative laboratory determinations, bedside airway adjuncts, and hospital stays of about 3 days. We propose a regimen for safe, cost-effective, short-stay total/near-total thyroidectomy.


METHODS
One hundred fifty total/near-total thyroidectomies performed between 1991 and 1994 were studied to test our short-stay thyroidectomy regimen. Patients were admitted the day of operation and observed overnight. Serum calcium values were obtained at 8, 14, and 20 hours after operation. Twenty-three-hour discharge criteria included no wound or airway problems, stable vital signs, tolerance of normal diet and activity, and an upsloping serum calcium curve.


RESULTS
Of 150 patients undergoing total/near-total thyroidectomy, 145 (97%) met 23-hour discharge criteria. No deaths (0%) occurred. Overall morbidity (six patients [4%)]) included one (0.7%) patient with postoperative hemorrhage, one (0.7%) patient with recurrent laryngeal nerve injury, three (2%) patients with transient hypocalcemia, and one (0.7%) patient with permanent hypocalcemia. Average length of stay was 1.06 days.


CONCLUSIONS
Significant airway and wound problems rarely develop beyond the first 12 to 18 hours after total/near-total thyroidectomy. Serial serum calcium determinations used to construct a three-point calcium curve at 20 hours after operation can reliably and safely identify patients at risk to have clinically significant hypocalcemia. Total/near-total thyroidectomy can be performed safely in a short-stay, 23-hour hospitalization setting with substantial cost savings.
D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D061224:Laryngeal Nerve Injuries; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage; D011446:Prospective Studies; D013965:Thyroidectomy / Q000191:economics* / Q000706:statistics & numerical data*
D002118:Calcium