Ambulatory thyroidectomy: A paradigm shift in surgical safety and patient-centered care

Despite longstanding concerns regarding life-threatening postoperative complications such as cervical hematoma, recent guidelines endorse ambulatory thyroidectomy as a safe and feasible option when performed under strict selection and monitoring. This study evaluated the safety and feasibility of ambulatory thyroidectomy in a high-volume endocrine surgery center.

All patients undergoing ambulatory thyroidectomy between May 1st, 2018, and December 31st, 2024 were retrospectively analyzed. Studied outcomes included hematoma, hypocalcemia, recurrent laryngeal nerve (RLN) injury, infection, and unplanned admission. One-step total thyroidectomy was not eligible for ambulatory care.

A total of 3047 adult patients (77% female; mean age 48.5±14 years) were included: 86% underwent lobectomy, 12% completion thyroidectomy, and 2% isthmectomy. In all, 954 (31%) were performed for malignant diseases. The proportion of ambulatory thyroidectomies among all partial thyroidectomy procedures increased from 7% in 2018 to 32% in 2024. Complication rates were low: hematoma (0.8%), including those requiring reoperation (19/23; 82.6%), transient RLN palsy (1.9%), symptomatic hypocalcemia (1.1%), permanent hypoparathyroidism (0.3%), and wound infection (0.2%).

Ambulatory thyroidectomy can be safely integrated into routine surgical practice when conducted within a structured perioperative pathway emphasizing meticulous patient selection, extended postoperative observation, and comprehensive patient education.