Outpatient Total Thyroidectomy Is Safe for Moderate-Volume Surgeons

Area of Science:

• Endocrinology
• Surgical Oncology
• Health Services Research

Background:

• Total thyroidectomy (TT) is increasingly performed as an outpatient procedure.
• Safety of same-day discharge for TT has been established for high-volume surgeons.
• Data on outpatient TT safety for low and moderate-volume surgeons are limited.

Purpose of the Study:

• To evaluate the safety of outpatient total thyroidectomy (TT) for moderate-volume surgeons.
• To compare readmission rates and emergency department visits between outpatient and inpatient TT.
• To determine the impact of surgeon volume on the safety of outpatient TT.

Main Methods:

• Retrospective review of 414 total thyroidectomies performed between 2005 and 2013.
• Patients categorized as outpatient if discharged on the same day as surgery.
• Comparison of demographic variables, comorbidities, postoperative calcium, and serum calcium between groups.

Main Results:

• Moderate-volume surgeons performed outpatient TT more frequently than low-volume surgeons (31.6% vs 6.0%).
• No correlation found between length of stay and readmission rates (P = 0.688).
• Readmitted patients had significantly lower postoperative serum calcium levels (8.3 mg/dL vs 8.8 mg/dL, P = 0.006).

Conclusions:

• Outpatient total thyroidectomy (TT) by moderate-volume surgeons demonstrates an acceptable safety profile regarding emergency department visits and readmissions.
• Same-day discharge for TT does not appear to influence readmission rates.
• Lower postoperative serum calcium is associated with readmission after TT.