Barriers to same-day discharge of patients undergoing total and completion thyroidectomy.
OBJECTIVE
Describe barriers to same-day surgery for patients undergoing total and completion thyroidectomy.


METHODS
Case series with chart review.


METHODS
Academic health sciences center.


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).


CONCLUSIONS
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.
Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas, USA.
Jonathan
J
Rutledge
Eric
E
Siegel
Ryan
R
Belcher
Donald
D
Bodenner
Brendan C
BC
Stack
D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data*; D001131:Arkansas / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy; D016896:Treatment Outcome
barriers; discharge; outpatient; thyroidectomy