Introduction of day care thyroid surgery in a Dutch non-academic hospital

Hemithyroidectomy is the most common endocrine surgical procedure and is performed with low complication rates. Multiple international reports indicate that thyroid surgery in the day care setting is feasible and safe. Despite these results, day care thyroid surgery has not yet been implemented in the Netherlands. The objective of this study is to assess the safety of thyroid surgery in our institution and, when deemed safe, implement day care thyroid surgery.

All patients who underwent hemithyroidectomy in our institution between January 2010 and December 2014 were included in the retrospective analysis. Hypothetical candidates for day care surgery were identified. All patients undergoing thyroid surgery in 2015 were included in a prospective cohort. Data regarding baseline characteristics, surgical procedures, complications and adherence to the day care schedule are presented.

A total of 210 patients were included in the retrospective cohort; 149 patients complied with the day care criteria. No complications occurred that would prevent day care surgery, or make it unsafe. Day care thyroid surgery was implemented from January 2015. In one year 43 patients underwent hemithyroidectomy. Thirty-one patients were eligible for day care surgery of which 18 patients were treated in day care. Failure of the day care regimen was due to the patient's own choice (n = 5), large retrosternal goitre (n = 2) or failure of logistics (n = 6). Besides transient hoarseness, no complications occurred in this group.

Based on a retrospective safety analysis we successfully introduced day care thyroid surgery in our clinic. Hemithyroidectomy can safely be conducted in day care setting. However, patient selection is of vital importance to minimise the risk of complications.