title: Ambulatory thyroidectomy: a multistate study of revisits and complications.
abstract: OBJECTIVE
  Determine rates and reasons for revisits after ambulatory adult thyroidectomy.
  
  
  METHODS
  Cross-sectional analysis of multistate ambulatory surgery and hospital databases.
  
  
  METHODS
  Ambulatory surgery data from the State Ambulatory Surgery Databases of California, Florida, Iowa, and New York for calendar years 2010 and 2011.
  
  
  METHODS
  Ambulatory thyroidectomy cases were linked to state ambulatory, emergency, and inpatient databases for revisit encounters occurring within 30 days. The numbers of revisits, mortality, and associated diagnoses were analyzed.
  
  
  RESULTS
  A total of 25,634 cases of ambulatory thyroid surgery were identified: 44.2% total thyroidectomy (TT) and 55.8% partial thyroidectomy (PT). Common indications for surgery included goiter/cyst (39.5%), benign/uncertain neoplasm (24.2%), and malignant neoplasm (24.0%). The 30-day revisit rate was 7.2% (n = 1858; 61.8% emergency department, 22.4% inpatient admission, and 15.8% ambulatory surgery center). The most common diagnosis at revisit was hypocalcemia (20.8% of revisits), followed by wound hematoma/seroma/bleeding (7.1%). Higher rates of revisit, hypocalcemia, and hematoma/seroma/bleeding were seen in patients undergoing TT (P < .016 for all). Sixteen patients had bleeding less than 24 hours after the index procedure (0.1% overall, 0.9% of revisits). Most hypocalcemia and hematoma/bleeding occurred over the first postoperative week. Three deaths occurred within 30 days of the index procedure.
  
  
  CONCLUSIONS
  In carefully selected patients, ambulatory thyroidectomy demonstrates a good postoperative morbidity and mortality profile. Common reasons for revisits included hypocalcemia and bleeding/seroma/hematoma, which occurred with relatively high frequencies as late as a week after surgery. Quality improvement measures should be targeted at lowering revisit rates and safely managing complications.
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, USA rorosco@ucsd.edu.
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Orosco
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, University of California-Irvine, Orange, California, USA.
authors.forename: Harrison W
authors.initials: HW
authors.lastname: Lin
authors.affiliation: Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Bhattacharyya
mesh_terms: D000328:Adult; D017677:Age Distribution; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006996:Hypocalcemia / Q000175:diagnosis / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis / Q000453:epidemiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000453:epidemiology; D018570:Risk Assessment; D017678:Sex Distribution; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology; D013959:Thyroid Diseases / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods*; D014481:United States
keywords: ambulatory surgical procedures; outpatient; perioperative complications; revisits; surgery; thyroid surgery; thyroidectomy