BACKGROUND
Thousands of people undergo surgery to remove their thyroid gland (total thyroidectomy) every year. The thyroid is a butterfly-shaped gland located in the front part of the neck that produces thyroid hormone. Common reasons for total thyroidectomy include treatment for thyroid cancer, non-cancerous thyroid enlargement (goiter) and thyroid over-activity (hyperthyroidism). Traditionally, people who undergo total thyroidectomy were admitted to the hospital, at least overnight, to monitor for rare complications that might develop after this surgery. Such complications include internal bleeding at the surgery site and low calcium levels, which can cause numbness, tingling and muscle spasms. By admitting a person to the hospital following total thyroidectomy, thyroid surgeons would hope to identify and treat these rare complications early and so minimize the dangers such complications may pose.

Fortunately, dangerous complications after total thyroidectomy are very rare, especially when this surgery is done by an experienced surgeon (called a high-volume thyroid surgeon). Because of this, many surgeons have started to discharge people who undergo total thyroidectomy from the hospital the same day the surgery is performed (called same day discharge) and a number of studies have shown this practice to be safe. Because most people prefer to be discharged from the hospital as soon as possible after surgery, same day discharge also tends to make most people’s surgery experience better. In addition, the less time someone spends in the hospital, the less expensive their surgery will be. For this reason, same day discharge after total thyroidectomy makes the cost of this surgery lower.

The authors of the study described here were interested in understanding how common same day discharge following total thyroidectomy is and also how surgeons decide whether or not same day discharge is appropriate for any given person who undergoes total thyroidectomy.

THE FULL ARTICLE TITLE
Hsu S et al 2023 Outpatient endocrine surgery practice patterns are highly variable among US endocrine surgery fellowship programs. Surgery 173:76–83. PMID: 36192212.

SUMMARY OF THE STUDY
The authors of this study asked surgeons enrolled in one of 22 different thyroid surgery training programs in the United States (endocrine surgery fellowships, all run by high-volume thyroid surgeons) how common people who undergo total thyroidectomy at their institutions were discharged from the hospital on the day of surgery. Institutions for which most patients were discharged on the day of total thyroidectomy (high same day discharge rate, >90%) were then compared to institutions for which some (moderate same day discharge rate, 3-89%) and few (low same day discharge rate, <2%) patients were discharged on the day of surgery.

The authors found that 9 of the 20 institutions that participated in their study rarely, if ever, discharged patients from the hospital following total thyroidectomy on the day of surgery (same day discharge rate <2%), while 7 institutions used same day discharge for >90% of patients undergoing total thyroidectomy. The remaining 4 institutions studied used same day discharge following total thyroidectomy on a moderate basis (3-89% of the time). In addition, the authors found that the length of time people undergoing total thyroidectomy were observed before being discharged from the hospital following surgery, even when not admitted to the hospital overnight, varied significantly between institutions. The reasons for deciding to admit a person to the hospital overnight after total thyroidectomy also differed among the institutions studied. The factors most likely to keep the patient overnight were that the patient lived alone, use of anticoagulation/antiplatelet agents, and more extensive surgery into the neck surrounding the thyroid.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
Previous studies have shown same day discharge following total thyroidectomy to be safe, cost-effective and preferred by patients. Nonetheless, this study highlights the fact that many institutions have not adopted the practice of same day discharge after total thyroidectomy. The reasons for this are not clear. In addition, previous studies have shown no increased risk of death after total thyroidectomy for patients who are discharged from the hospital on the day of surgery. The study presented here indicates a need to develop common standards for same-day discharge among institutions where total thyroidectomy is performed, so that all people undergoing thyroid surgery have the safest, most efficient, cost-effective and pleasant surgery experience possible.

— Jason D. Prescott, MD PhD

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