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Published on: September 20, 2024
Association of same-day discharge with hospital readmission after pediatric thyroidectomy
Jasmine Bhinder1, Kathleen Bethin2, Moshim Kukar3
1Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 1001 Main Street, Buffalo, NY, 14203, USA. jbhinder@buffalo.edu.
Insights
Same-day discharge (SDD) for pediatric thyroid surgery is safe, with no increased risk of readmission or wound complications compared to later discharge. This approach may be suitable for select pediatric patients undergoing thyroidectomy.
Area of Science:
- Pediatric Surgery
- Endocrine Surgery
- Patient Outcomes
Background:
- Same-day discharge (SDD) is established as safe for adult thyroidectomy patients.
- Limited data exists on SDD safety and feasibility in pediatric thyroid surgery.
- Pediatric thyroid surgery outcomes require further investigation regarding discharge timing.
Purpose of the Study:
- To evaluate the impact of same-day discharge (SDD) on 30-day readmission rates in pediatric patients undergoing thyroidectomy.
- To assess secondary outcomes including wound complications, unplanned reoperation, and mortality in pediatric thyroid surgery patients discharged on the same day versus later.
Main Methods:
- Retrospective cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program-Pediatric database (2012-2017).
- Included pediatric patients (<19 years) undergoing thyroid resection, excluding those discharged >2 days post-surgery.
- Primary outcome: 30-day readmission. Secondary outcomes: wound complications, reoperation, death. Analyzed using chi-squared tests and multivariate logistic regression.
Main Results:
- 1125 pediatric patients (79% female, median age 15) were analyzed; 122 (11%) underwent SDD.
- Total/near-total thyroidectomy was common (63.5%); these patients were less likely to have SDD (4.3% vs. 22.1% for lobectomy, P<0.001).
- No significant difference in 30-day readmission rates (2.46% SDD vs. 2.59% later discharge; aOR 1.04, P=0.96) or wound complications (none in SDD group vs. 2 in later discharge group).
Conclusions:
- Same-day discharge for pediatric thyroidectomy is not associated with increased 30-day readmissions or wound complications.
- SDD appears to be a safe and viable option for select pediatric patients following thyroid surgery.
- Results support considering SDD as an alternative to traditional overnight stays in carefully selected pediatric cases.
Background:
Studies have demonstrated that same-day discharge (SDD) following thyroid resection is safe and feasible in adults but there are no similar studies in the pediatric age group. The purpose of this study is to evaluate the influence of SDD on 30-day readmission rates following thyroid surgery in pediatric patients.
Methods:
This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program-Pediatric database to evaluate 30-day readmission rates among patients < 19 years of age who underwent thyroid resection between 2012 and 2017. Patients excluded were those discharged more than 2 days after surgery. The main exposure variable was SDD and the primary outcome was 30-day readmission. Secondary outcomes included wound complications, unplanned reoperation and death. Patient characteristics were compared using chi-squared testing and odds ratios for readmission were calculated using multivariate logistic regression.
Results:
Of the 1125 patients (79% female, median age 15 years), 122 (11%) were discharged on the day of surgery. Total or near-total thyroidectomy represented the majority of operations (714, 63.5%) and patients undergoing these operations were less likely to be discharged on the same day as surgery compared to those undergoing thyroid lobectomy (4.3 vs. 22.1%, P < 0.001). Twenty-nine patients were readmitted within 30 days (3 in the same day group, 26 in the later group). There was no difference in the odds of readmission between the two groups (adjusted odds ratio in SDD compared to later discharge 1.04 [95% CI 0.29-3.75, P = 0.96; readmission rate, 2.46 vs. 2.59%). Wound complications were reported in two patients, both in the later discharge group.
Conclusion:
Same-day discharge in pediatric patients undergoing thyroidectomy is not associated with an increase in 30-day readmissions or wound complications when compared to patients discharged 1 or 2 days after surgery. In selected patients, SDD may be an appropriate alternative to traditional overnight stay.
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