EVALUATION OF TOTAL NEAR-TOTAL THYROIDECTOMY IN A SHORT-STAY HOSPITALIZATION - SAFE AND COST-EFFECTIVE

Background. Once the decision of perform total/near-total thyroidectom y has been made, common perioperative management strategies include fr equent postoperative laboratory determinations, bedside airway adjunct s, and hospital stays of about 3 days. We propose a regimen for safe, cost-effective, short-stay total/near-total thyroidectomy. Methods. On e hundred fifty total/near-total thyroidectomies performed between 199 1 and 1994 were studied to test our short-stay thyroidectomy regimen. Patients were admitted the day of operation and observed overnight. Se rum calcium values were obtained at 8, 14, and 20 hours after operatio n. Twenty-three-hour discharge criteria included no wound or airway pr oblems, stable vital signs, tolerance of normal diet and activity, and an upsloping serum calcium curve. Results. Of 150 patients undergoing total/near-total thyroidectomy, 145 (97%) met 23-hour discharge crite ria. No deaths (0%) occurred. Overall morbidity (six patients [4%)]) i ncluded one (0.7%) patient with postoperative hemorrhage, one (0.7%) p atient with recurrent laryngeal nerve injury, three (2%) patients with transient hypocalcemia, and one (0.7%) patient with permanent hypocal cemia. Average length of stay was 1.06 days. Conclusions. Significant airway and wound problems rarefy develop beyond the first 12 to 18 hou rs after total/near-total thyroidectomy. Serial serum calcium determin ations used to construct a three-point calcium curve at 20 hours after operation can reliably and safely identify patients at risk to have c linically significant hypocalcemia. Total/near-total thyroidectomy can be performed safely in a short-stay, 23-hour hospitalization setting with substantial cost savings.