Back to 2025 Abstracts
Same-Day Total Thyroidectomy is Safe in a High-Volume Safety Net Hospital
Heejoo Kang
*1, Lauren Hartnett
2, Andrea Merrill
2, David McAneny
2, Frederick T. Drake
21Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA; 2Surgery, Boston Medical Center, Boston, MA
BackgroundSame-day total thyroidectomy (TT) is supported by evidence for good outcomes and patient preference. However, this practice is not universally accepted, and some have expressed concerns about its role among patients with socioeconomic disadvantages, such as language barriers or transportation difficulties. We hypothesized that a protocolized same-day TT program would be safe for well-selected patients in a safety net hospital setting.
Methods A formal same-day TT program was initiated in January 2023. Data were collected prospectively. Prior to surgery, surgeons were queried whether their patient was a candidate for same-day surgery. Thyroidectomy-specific outcomes and resource utilization data were collected in a standardized fashion. Outcomes and clinical/demographic features of patients who underwent same-day TT were compared to those who stayed in hospital overnight. Indications for unplanned admission were analyzed. Patients with central neck dissection were included, but those with lateral neck dissections were excluded from analysis. Initially, Graves’ disease was an exclusion criteria, but later in the study, patients with Graves’ disease were eligible for same day surgery.
ResultsOver the study period, surgeons performed TT in 140 patients (55% Medicaid, 52.9% non-English speaking). 66 patients met pre-operative criteria for same-day surgery. Among those who did not, 28.6% had more than one exclusion criteria. 50 patients (35% of all patients, 76% of those who met criteria) were discharged on the same day. Safety and quality outcomes were similar between groups. Among the 50 outpatients, three (6%) had parathyroid hormone (PTH) level <4, and a single-patient returned on post-operative day one for operative evacuation of a neck hematoma. Twice as many overnight observation patients (12%) were seen in the emergency department or re-admitted compared to same-day TT patients (6%). Of 66 planned same-day discharges, 18 patients instead stayed overnight: five for PTH<12, two for neck swelling or hematoma, and 11 for other reasons (e.g., fall risk in PACU). Two patients who were planned overnight stay, preferred same-day surgery and went home from the PACU. For same-day TT, median in-hospital post-operative time was 5.7 hours (IQR 4.7-6.3 hours) compared to 22 hours (IQR 18.6-23.7 hours) for overnight observation patients. Adoption of same-day TT increased from 32% in the first quarter to 73% in the most recent quarter.
ConclusionSafe implementation of a same-day TT program is feasible in a safety-net patient population with thoughtful patient selection. No emergency post-operative complications manifested following same-day discharge, and the single neck hematoma was not airway threatening. Utilization increased dramatically over the two-year study period. This post-operative strategy reduced in-house post-operative time by approximately 16 hours, improving patient experience and ameliorating hospital capacity challenges.
Endocrine Surgery-specific Outcomes following Total Thyroidectomy
| | Total | Overnight Stay | Same-day discharge |
| Number | 140 | 90 | 50 |
| RLN concern, temporary, N (%) | 2 (1.4%) | 1 (1.1%) | 1 (2.0%) |
| RLN concern, >6 months, N (%) | 0 (0%) | 0 (0.0%) | 0 (0.0%) |
| PACU PTH <4, N (%) | 11 (7.9%) | 8 (8.9%) | 3 (6.0%) |
| PACU PTH 4-12, N (%) | 32 (22.9%) | 22 (24.4%) | 10 (20.0%) |
| PACU PTH >12, N (%) | 97 (69.3%) | 60 (66.7%) | 37 (74.0%) |
| Low PTH at 6 months, N (%) | 1 (0.7%) | 1 (1.1%) | 0 (0.0%) |
| Hematoma evacuation, N (%) | 4 (2.9%) | 3 (3.3%) | 1 (2.0%) |
| Other complications, N (%) | 11 (7.9%) | 9 (10.0%) | 2 (4.0%) |
| Readmission / ED visit, N (%) | 14 (10.0%) | 11 (12.2%) | 3 (6.0%) |
Back to 2025 Abstracts
