A Retrospective Study on the Duration of Stay After Completion and Total Thyroidectomy

Introduction Thyroidectomy is the most common endocrine head and neck surgery. First-time hemithyroidectomies have been shown to have lower rates of complications such as recurrent laryngeal nerve palsy and hypocalcaemia, when compared to total and completion thyroidectomies, due to dissection occurring on one side in hemithyroidectomies. As a result, hemithyroidectomies (low risk) can be performed as day-case surgeries, while higher-risk total and completion thyroidectomies are more likely to have inpatient care postoperatively. This study aims to examine postoperative admission duration and outcomes following completion and total thyroidectomy in a single centre. Methods This retrospective, observational, descriptive review included 137 cases of total and completion thyroidectomies carried out at the Department of Otolaryngology, York District Hospital, UK, over four years. The outcome was defined as the presence or absence of complication(s) in the first 30-day postoperative period. Postoperative duration was classified into less than one day, one day to less than two days, two days to less than three days, and three days or more of inpatient care before discharge. Results A total of 137 patients met the study criteria. There were 77 total thyroidectomies and 60 completion thyroidectomies. Nineteen patients had a postoperative stay of less than one day, 70 patients had between one day and less than two days postoperative care, 22 patients had two days to less than three days admission, and 26 patients had a postoperative stay of three days or more. There were 104 females and 33 males. The mean age was 51.10 ± 15.42 years, with an age range of 17-90 years. Overall, the most common preoperative diagnosis was cancer (n = 52), all of which had a complete thyroidectomy. Thyrotoxicosis (n = 45) was the second-highest indication. Hypocalcaemia was the most common cause of delayed discharge postoperatively, accounting for 58.3% (n = 14) of all patients who stayed more than three days after surgery. Of all obese patients, 51% had a postoperative stay of two or more days. A total of 106 patients (80.3%) had a drain inserted, and the use of a drain was related to extended hospital stay postoperatively (Chi-square value = 8.989, p = 0.029). There was no statistically significant relationship between the use of drains and prevention of symptomatic seroma (Chi-square value: 0.011, p = 0.918, Fisher's p = 1.000). There were five (3.6%) cases of postoperative haematoma, and one of those five did not have a drain (Chi-square value = 0.000, p = 0.987, Fisher's p = 1.000). All five postoperative haematoma patients had total thyroidectomy (Chi-square value = 4.044, p = 0.044, Fisher's p = 0.068). Patients with higher BMI were more likely to have a longer postoperative stay in the hospital (Chi-square value: 24.967, p = 0.003). Of those who stayed two days to less than three days, 86.3% were either overweight or obese, and 84.6% of patients who stayed three or more days were also either overweight or obese. Conclusion The use of drains, BMI of the patient, and development of hypocalcaemia are associated with extended in-hospital stay following total and completion thyroidectomy. Planning for early discharge requires careful patient selection, with close monitoring in the observation period before discharge, while ensuring adequate availability of support and proximity to hospital or emergency response systems after discharge, for patient safety.