Introducing day case thyroid lobectomy at a tertiary head and neck centre

Abstract

Background Thyroid lobectomy is considered to be a safe day case procedure by the British Association of Day Surgery. However, currently only 5.5% of thyroid surgeries in the UK are undertaken as day cases. We determine if and how thyroid lobectomy with same-day discharge could safely be introduced in our centre. Methods We analysed all thyroid lobectomy surgeries performed between April 2015 and May 2019. Exclusion criteria included completion surgery, revision surgery, additional procedures and disseminated disease. Outcomes were benchmarked against surgeon-reported complications from the British Association of Endocrine and Thyroid Surgery’s 5th National Audit. Additionally, we reviewed the number of patients who met day case criteria currently in use at our hospital to determine accessibility to the service. Results In total, 259 thyroid lobectomy surgeries were undertaken and of these 173 met the inclusion criteria. There was no mortality, return to theatre for evacuation of postoperative haematoma or readmission. There was one postoperative haematoma which was drained at the bedside. Some 47 of the 173 (27.2%) patients met day case criteria currently in use at our centre. Conclusions Day case surgery provides a cost-effective solution to rising bed pressures and a coherent protocol can optimise patient safety and experience.

Risk of hematoma after hemithyroidectomy in an outpatient setting: a systematic review and meta-analysis

“…In 2021 Sheikh et al [ 47 ] investigated if outpatient hemithyroidectomy could be safely introduced in their centre. The study began with a literature-review reporting on experiences with outpatient hemithyroidectomy.…”

Unilateral Thyroid Lobectomy as Day Care Procedure: A Cross Sectional Study with Literature Review on the Safety and Cost Effectiveness

“…8 The requirement for discharge is adequate pain control on oral analgesics, tolerating diet, and good understanding of the possible complications. 8 The decision for this consideration has to be based on empirical evidence of both an appropriate preoperative patient condition and the provision of good home health care to ensure minimization of emergency room visits and readmissions with complications 11,13 With outpatient thyroidectomy, an added advantage is the decreased risk of nosocomial infections. 6,8 There is a certain reduction in charges; according to ATA, a reduction of USD 2,500 in the cost of ambulatory thyroid surgery can be observed.…”

“…8 The requirement for discharge is adequate pain control on oral analgesics, tolerating diet, and good understanding of the possible complications. 8 The decision for this consideration has to be based on empirical evidence of both an appropriate preoperative patient condition and the provision of good home health care to ensure minimization of emergency room visits and readmissions with complications 11 13…”