Outpatient and short-stay thyroid surgery

With the realization that simple thyroid procedures had a very low rate of complication and that patients often seemed well enough to go home from the recovery room, we began performing them in an ambulatory surgery setting. We review here 134 consecutive thyroid procedures performed at Columbia Presbyterian Medical Center between July 1987 and July 1989. Patients undergoing reoperation, neck dissection, sternal splits, or other concomitant procedures were excluded. There were 105 women and 29 men with an average age of 47 years. Fifty percent of the operations were performed for benign disease, although the most common diagnosis was papillary cancer (44%). Twenty-one operations (16%) were performed under local anesthesia. Most patients underwent surgery in our ambulatory surgery unit and 76 were discharged the day of surgery. Of these patients, 21 underwent total thyroidectomy, 13 subtotal thyroidectomy, and 42 simple thyroid lobectomy. Of the 58 patients who were admitted, 53 were discharged on the day following surgery. The average length of stay was 0.49 days. Extensive pre- and postoperative teaching was given regarding the signs and symptoms associated with the complications of thyroid surgery. All patients were felt to be reliable and capable of understanding the procedure and of complying with the postoperative plans. Postoperative complications included 8 patients (6%) with transient hypocalcemia and 1 patient (0.75%) with permanent unilateral recurrent laryngeal nerve paralysis. All complications occurred in patients who underwent total thyroidectomies. No patient had a postoperative complication requiring reoperation or readmission. We conclude that by using specific selection criteria, thyroid lobectomies and subtotal thyroidectomies can be performed safely in an ambulatory surgery setting without increase in morbidity or mortality.