Outcome of routine discharge after a 4-hour postanesthesia care stay following thyroid lobectomy

Patients who undergo thyroid lobectomy are routinely observed for 4 hours in the postanesthesia care unit and are discharged if there is no evidence of neck hematoma. The aim of this study was to determine the outcome of routine discharge after a 4-hour observation following thyroid lobectomy.

A retrospective review of consecutive patients who underwent thyroid lobectomy from 2008 to 2023 was completed. Patients were evaluated for neck hematoma requiring urgent evacuation, emergency department visits, and hospital readmission. Univariate analysis and multivariate regression analysis were used to analyze potential factors associated with an unsuccessful discharge after 4 hours of observation.

A total of 494 patients underwent thyroid lobectomy; 330 (67%) were discharged after a 4-hour postanesthesia care unit stay (group I), and 164 (33%) were observed overnight (group II). Neck hematoma occurred in 2 (0.4%) patients before they were both discharged. Thirty-seven (7%) patients presented to the emergency department, 23 (7%) from group I and 14 (9%) from group II (P = .53). Six (1%) patients were readmitted, 3 (1%) from groups I and 3 (2%) from group II (P = .38). Factors independently associated with an overnight stay and their odds ratio and confidence interval were dependent status (10.76, 2.18-53.07), American Society of Anesthesiologists class ≥3 (5.32, 2.04-13.86), increased blood loss (4.00, 1.04-2.45), age >50 years (2.68, 1.38-5.20 years), and substernal extension (1.60, 1.04-2.45).

Discharge to home after 4 hours of observation is safe after thyroid lobectomy. However, patients who are older, dependent, have an American Society of Anesthesiologists score ≥3, or undergo a more difficult operation should be prepared for overnight observation.