Outpatient Thyroidectomy Is Safe and Reasonable: Experience with More than 1,000 Planned Outpatient Procedures

BACKGROUND: Thyroidectomy has traditionally been performed as an inpatient hospital procedure, but low risk and high patient tolerance make it acceptable as an outpatient procedure. STUDY DESIGN: All thyroidectomies performed by a single surgeon between March 2003 and June 2009 were retrospectively and prospectively reviewed as planned outpatient or planned inpatient operations, noting the patient's American Society of Anesthesiologists (ASA) classification, success of completion as an outpatient procedure, time to same-day discharge, postoperative emergency room visit, hospital admission, and complications. RESULTS: Overall, 1,136 of 1,242 thyroidectomies were planned as outpatient procedures and 1,063 (93.6%) were successfully completed as such. Including 1 outpatient procedure initially planned as an inpatient procedure, 1,064 outpatient procedures were performed, of which 613 were total and 451 less-than-total thyroidectomies. These outpatient procedures had a mean rime to day-surgery discharge of 2 hours and 42 minutes. Of discharged outpatients, a postoperative emergency room visit within 30 days occurred in 83 cases (7.8%), with subsequent hospital admission in 25 of these patients (2.3%). Excluding 153 cases of isolated and self-limited asymptomatic hypocalcemia (14.4%), substantial complications occurred in 122 discharged outpatients (11.5%), including 56 symptomatic hypocalcemias (5.20%), 39 transient recurrent laryngeal nerve injuries (3.7%), 4 permanent recurrent laryngeal nerve injuries (0.4%), and 2 hematomas (0.19%). None of the patients with postoperative hematoma required bedside decompression and only 1 occurred within 24 hours of the outpatient procedure. Discharged outpatient thyroidectomy patients were younger (53 years versus 60 years; p < 0.0001) and healthier (2.3 ASA versus 3.0 ASA; p < 0.0001) than planned inpatient thyroidectomies. CONCLUSIONS: Outpatient thyroidectomy in experienced hands is safe and reasonable with favorable patient acceptance and the potential for substantial health care cost savings. (J Am Coll Surg 2010;210: 575-584. (C) 2010 by the American College of Surgeons)