title: An Evaluation of Postoperative Complications and Cost After Short-Stay Thyroid Operations.
abstract: BACKGROUND
  Concern for postoperative complications causing airway compromise has limited widespread acceptance of ambulatory thyroid surgery. We evaluated differences in outcomes and hospital costs in those monitored for a short stay of 6 h (SS), inpatient observation of 6-23 h (IO), or inpatient admission of >23 h (IA).
  
  
  METHODS
  We retrospectively reviewed all patients undergoing thyroidectomy from 2006 to 2012. The incidence of postoperative hemorrhage, nerve dysfunction, and hypocalcemia were evaluated, as well as cost data comparing the SS and IO groups.
  
  
  RESULTS
  Of 1447 thyroidectomies, 880 (60.8 %) were performed as SS, 401 (27.7 %) as IO, and 166 (11.5 %) as IA. Fewer patients in the SS group (59 %) underwent total thyroidectomy than IO (73 %) and IA (71 %; p < 0.01), and SS patients had smaller thyroid weights (27.9 g) compared with IO and IA (47.2 and 98.9 g, respectively; p < 0.01). Ten (0.69 %) patients developed hematomas requiring reoperation, five of the ten patients received antiplatelet or anticoagulant therapy perioperatively. Only one patient in the IA group bled within the 6- to 23-h period, and no patients with bleeding who were discharged at 6 h would have benefitted from 23-h observation. Twenty-four (1.66 %) recurrent laryngeal nerve injuries were identified, 16 with temporary neuropraxias. In addition, 24 (1.66 %) patients had symptomatic hypocalcemia, which was transient in 17 individuals. Financial data showed higher payments and lower costs associated with SS compared with IO.
  
  
  CONCLUSIONS
  Selective SS thyroidectomy can be safe and cost effective, with few overall complications in patients undergoing more complex operations involving larger thyroids who were admitted to hospital.
authors.affiliation: Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Narayanan.sumana@gmail.com.
authors.forename: Sumana
authors.initials: S
authors.lastname: Narayanan
authors.affiliation: Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Dena
authors.initials: D
authors.lastname: Arumugam
authors.affiliation: Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Mennona
authors.affiliation: Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
authors.forename: Marlene
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.|Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
authors.forename: Tomer
authors.initials: T
authors.lastname: Davidov
authors.affiliation: Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.|Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
authors.forename: Stanley Z
authors.initials: SZ
authors.lastname: Trooskin
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000175:diagnosis / Q000191:economics* / Q000209:etiology; D006801:Humans; D006996:Hypocalcemia / Q000175:diagnosis / Q000191:economics* / Q000209:etiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics*; D011379:Prognosis; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000191:economics / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000191:economics*