title: PACU PTH facilitates safe outpatient total thyroidectomy.
abstract: OBJECTIVE
  To determine if a serum parathyroid hormone (PTH)-based discharge algorithm can be used to safely facilitate outpatient total thyroidectomy.
  
  
  METHODS
  Case series with chart review of consecutive total and completion thyroidectomies performed by the senior author from March 2008 to November 2009.
  
  
  METHODS
  An academic tertiary care center.
  
  
  METHODS
  At the authors' institution, patients undergoing total or completion thyroidectomy are subject to a same-day discharge algorithm that incorporates postanesthesia care unit rapid PTH as the major discharge criterion. Patients with PTH >30 pg/mL are eligible for same-day discharge without supplementation, patients with PTH between 20 and 30 pg/mL are eligible for discharge but receive calcium supplementation, and patients with PTH <20 pg/mL are observed overnight (23 hours) with calcium and vitamin D supplementation.
  
  
  RESULTS
  One hundred eighty patients (mean age, 48.9 years; 83.3% female) underwent total (77.2%) or completion (22.7%) thyroidectomy with or without node dissection. Forty-two percent were performed with minimally invasive video-assisted (MIVA) technique. Seventy-six percent (137/180) of patients had a PTH >20 pg/mL, meeting the PTH discharge criterion. Sixty-nine percent (95/137) of eligible patients were discharged on the same day (53.1% of total). Ten percent of discharge-eligible patients were admitted due to drain placement. Of the 95 patients undergoing outpatient surgery, none were admitted, seen, or called for symptoms of hypocalcemia in the postoperative period. All 180 patients were eucalcemic at postoperative day (POD) 7 and POD 30 office visits. No patients were hypoparathyroid at POD 30. No significant difference in postoperative hypoparathyroidism existed between completion versus total thyroidectomy (11.1% vs 22.2%, P = .28) or MIVA versus standard technique (P = .37).
  
  
  CONCLUSIONS
  A PTH-based discharge algorithm can safely facilitate outpatient total or completion thyroidectomy, with minimal risk of clinically significant outpatient hypocalcemia.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio 45267-0528, USA. houltojy@ucmail.uc.edu
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Houlton
authors.forename: William
authors.initials: W
authors.lastname: Pechter
authors.forename: David L
authors.initials: DL
authors.lastname: Steward
mesh_terms: D000465:Algorithms; D000556:Ambulatory Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006996:Hypocalcemia / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009820:Ohio / Q000453:epidemiology; D010281:Parathyroid Hormone / Q000097:blood*; D010351:Patient Discharge / Q000639:trends*; D012189:Retrospective Studies; D012307:Risk Factors; D013959:Thyroid Diseases / Q000097:blood / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome; D020535:Video-Assisted Surgery
chemical_list: D010281:Parathyroid Hormone