The Safety of Outpatient Total Thyroidectomy

Abstract

Objectives: Establish whether total thyroidectomy can be performed safely in the outpatient setting.Methods: This was a retrospective review of 410 total thyroidectomies performed by a single surgeon between 2009-2012. Of these, 241 were performed as an outpatient surgical procedure. Outcome measures included symptomatic hypocalcemia, readmission for hypocalcemia, true vocal cord paralysis/ paresis, hematoma, and overall readmission rate.Results: Of the total thyroidectomies performed by a singlesurgeon between 2009-2012, 241/410 (59%) were outpatient procedures. Symptomatic hypocalcemia occurred in 12/241 (4.9%) and readmission for hypocalcemia occurred in 4/241 (1.6%). True vocal cord paralysis was not observed, however 5/241 (2.1%) did have transient vocal cord weakness that resolved without further intervention. Hematoma requiring surgical intervention occurred in 2/241 (0.8%). Overall readmission rate was 5/241 (2.1%).Conclusions: Though traditionally an inpatient procedure; our experience indicates that outpatient thyroidectomy is a safe and reasonable option.

Outpatient versus inpatient thyroidectomy: A systematic review and meta‐analysis

“…Ten studies, including those by Lacroix et al (2014) and Black et al (2015), were included in the meta‐analysis of readmission/reintervention rates . The results demonstrated a pooled RR of 0.60 (95% CI 0.33‐1.09; P = .09) favoring the outpatient group, although this was not statistically significant (see Figure ).…”

“…The remaining 49 articles were reviewed in full text. Of these, 11 studies were included for qualitative analysis and 10 were included for quantitative analysis . The observed unweighted kappa for full‐text screening between the 2 independent reviewers was 0.779 (95% CI 0.573‐0.987), suggesting a “good” level of agreement.…”

“…Studies used similar criteria for selecting patients for outpatient surgery (Table ) . Most studies used social support, geographical proximity, comorbidities, age, and bleeding risks for the selection process.…”

“…No deaths resulted from postoperative hematoma. With regard to hypocalcemia, only the 3 studies that solely evaluated total or completion thyroidectomy were included . Black et al (2015) did not report hypocalcemia separately and, therefore, was not included in the results.…”

“…Eight studies were included in the meta‐analysis of complication rates, which included hematoma, seroma, airway complications, recurrent laryngeal nerve injury, hypocalcemia, and other reported findings . The study by Marino et al (2014) was excluded because it was a cross‐sectional study that was not appropriate to pool with cohort study designs.…”