Thyroid surgery and postoperative hospital stay

The duration of hospital stay following surgical procedures has undergone a significant reduction in the last 10 years. With advances in anaesthesia, immediate postoperative care and surgical techniques, increasingly more procedures, such as hernia repair, laparoscopic cholecystectomy, breast surgery and other minor operations, are now performed on an outpatient surgery basis. Outpatient surgery is defined as same-day discharge from a hospital-based surgical unit, not requiring an overnight hospital or postoperative recovery unit stay. The rationale for performing same-day surgery relies on a combination of criteria such as the short time of the procedure, the use of new techniques of coagulation, the excellent immediate recovery which includes no pain, immediate mobilization, alimentation, and mental clarity. Traditionally, patients undergoing thyroid surgery are observed for up to 48-72 hours before discharge. Recently, short-stay thyroid surgery or ambulatory thyroid surgery (<24 hours hospital stay) has been performed. Short-stay thyroid surgery is reported in the literature as safe and cost-effective. However, there are specific issues in thyroid surgery that need to be taken into consideration. Although there are a number of retrospective reviews that attempt to determine the eligibility criteria for outpatient thyroidectomy, a one-day clinic still cannot be applied to thyroid procedures because of the potentially deadly complication of a haemorrhage. A postoperative haemorrhage in the neck after thyroid surgery demands immediate management and at least 25% require immediate bedside intervention. In Greece, ambulatory thyroid surgery cannot be endorsed due to safety concerns regarding the patient. At the moment, neither the means nor the methods support one-day thyroid surgery. The inability to immediately treat postoperative bleeding renders short-stay thyroid surgery (<23 hours) dangerous for the patient. For this reason, an overnight hospital stay is suggested for thyroid surgery as it appears safe for both the patient and the surgeon.