Short stay thyroid surgery: a personal experience

Abstract

Introduction: In spite of a low incidence of complications during thyroidectomy, there is a widespread tendency to extend hospitalization at least until postoperative second day. The need of a rebalancing between costs and profits had led us to revise the hospitalization’s duration. Methods: We reviewed our early experience (129 patients candidated to total thyroidectomy as ordinary hospitalization from 2001 to 2002) identifying the causes of hospitalization’s delay both preoperatively and in discharge. We excluded from our analysis re-operations, substernal goitre requiring sternotomy, carcinomas needing a systematic lymphadenectomy and some cases of internal medical interest. Between June 2003 and June 2007, 708 patients meeting the same criteria were referred to a short hospitalization (one-day surgery) after their expressed consent; during surgical operation hemostasis was improved with special remedy in 545 cases; after thyroidectomy all patients were subjected to a empirical protocol to prevent hypocalcaemia. Results: Between 2003 and 2007 the average of postoperative hospitalization was 1.08 days; the causes of extension were: severe/symptomatic hypocalcaemia (45 patients), re-operation because of hematoma (1 case), one tracheotomy for transient bilateral paralysis of recurrent nerve; 2 patients were readmitted for local sepsis. This procedure has been successful in 92.8% of cases. 701 patients properly interrogated have declared to be satisfied. Conclusions: A rational management of patients to undergo a total thyroidectomy with a careful emphasis on prevention of hypocalcaemia makes sure the short stay. The advantages in terms of economics are obvious. Additional benefits seem to come from the introduction of “mini invasive” techniques.