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Same-day discharge safe for thyroidectomy patients
WASHINGTON — Patients who have undergone thyroidectomy can be safely discharged on the same day when an institution-specific protocol, adapted from the American Thyroid Association Statement on Outpatient Thyroidectomy, is applied, according to data presented at the 88th Annual Meeting of the American Thyroid Association.
“Our retrospective review of patient demographics, comorbidities and perioperative sequelae demonstrated that [approximately] 84% of thyroidectomy patients are potentially eligible for same-day discharge,” Natalie S. Justicz, MD, otolaryngology surgical resident at Massachusetts Eye and Ear Infirmary, told Endocrine Today. “From this data we are implementing our institution-specific discharge protocol to safely and efficiently discharge our thyroidectomy patients.”
To determine which patients were eligible for same-day discharge, researchers conducted a retrospective review of thyroidectomies performed by a single surgeon.
Between September 2017 and February 2018, researchers reviewed records from 89 adults undergoing hemithyroidectomy, total thyroidectomy or completion thyroidectomy. Patients who underwent total and completion thyroidectomy had 2-hour postoperative parathyroid levels measured, and researchers reviewed charts for demographics, comorbidities and surgical sequelae of hematoma, hypocalcemia and recurrent laryngeal nerve injury.
Researchers then reviewed ATA preoperative, perioperative and postoperative discharge criteria and established a parathyroid level cutoff of 15 pg/mL.
Seventy-five patients were eligible for same-day discharge (48 total thyroidectomies; 6 completion thyroidectomies), and none experienced hematoma, postoperative stridor or the need to return to the operating room, according to the researchers.
“Thyroid surgery outcomes at our institution, Massachusetts Eye and Ear, are excellent,” Justicz said. “In the past, all patients undergoing thyroidectomy have stayed overnight for airway observation and calcium monitoring. Surgical advances in neural monitoring as well as parathyroid preservation and immediate postsurgical [parathyroid] assessment have allowed safe same-day thyroidectomy discharge.” – by Melissa J. Webb
Reference:
Justicz NS, et al. Poster 108. Presented at: 88th Annual Meeting of the American Thyroid Association; Oct. 3-7, 2018; Washington, D.C.
Disclosures: The authors report no relevant financial disclosures.