title: Changing trends in thyroid and parathyroid surgery over the decade: is same-day discharge feasible in the United Kingdom?
abstract: BACKGROUND
  A recent British Association of Endocrine and Thyroid Surgeons consensus document suggested that day-case thyroidectomy is feasible in a small proportion of patients but has to be balanced against risks. Currently, there is no large reported series of same-day discharge in thyroid and parathyroid surgery from the UK. The aim of this study was to assess the outcomes of day-case thyroid and parathyroid surgery.
  
  
  METHODS
  We conducted a retrospective study of patients who underwent thyroid or parathyroid surgery between January 2000 and December 2011 at Oxford University Hospitals. The end points analysed were complications in the form of bleeding, hypocalcaemia, wound infection, and seroma.
  
  
  RESULTS
  A total of 2,102 patients (495 males and 1,607 females, age range = 13-90 years) underwent surgery for parathyroid (n = 776) or thyroid (n = 1,326) conditions. The operations included minimally invasive parathyroidectomy (MIP) (n = 331), open parathyroidectomy (n = 445), lobectomy (n = 687), isthmusectomy (n = 23), total thyroidectomy (n = 580) and thyroglossal cyst excision (n = 36). Routine arrangements were in place for consideration of same-day discharge for lobectomies, thyroglossal cyst surgery, and MIPs; lobectomies accounted for 63 % of same-day cases, followed by parathyroidectomy (35 %). Over the decade, day-case surgery increased from 4 to 17 % for thyroid surgery and from 20 to 40 % for parathyroid surgery. None of the 435 patients who had same-day discharge was readmitted for bleeding [confidence interval (CI) 0-0.6 %]. There was no 30-day mortality for the whole cohort. Complications in patients who underwent surgery in the whole cohort versus those who were discharged the same day were temporary hypocalcaemia (4 vs. 0.2 %), permanent hypocalcaemia (1 vs. 0.4 %), bleeding (0.4 vs. 0 %), seroma (0.3 vs. 0 %), and wound infection (0.3 vs. 0 %).
  
  
  CONCLUSIONS
  Current protocols for thyroid or parathyroid surgery make same-day discharge feasible and safe in carefully selected patients.
authors: Department of Endocrine Surgery, National University Hospital, 1E, Kent Ridge Road, Singapore, 119228, Singapore, malumols@live.co.uk.
authors: Parameswaran
authors: P
authors: Rajeev
authors: Rupesh
authors: R
authors: Sutaria
authors: Tarek
authors: T
authors: Ezzat
authors: Radu
authors: R
authors: Mihai
authors: Gregory P
authors: GP
authors: Sadler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000639:trends*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010279:Parathyroid Diseases / Q000601:surgery*; D016105:Parathyroidectomy / Q000009:adverse effects / Q000639:trends*; D010351:Patient Discharge; D019106:Postoperative Hemorrhage / Q000209:etiology; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D013955:Thyroglossal Cyst / Q000601:surgery; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000639:trends*; D006113:United Kingdom; D055815:Young Adult