Same-Day Total Thyroidectomy Is Safe in a High-Volume Safety-Net Hospital

Abstract

Background: Same-day total thyroidectomy is supported by earlier studies, yet adoption remains limited, particularly in safety-net hospitals where socioeconomic barriers may complicate outpatient care. We prospectively evaluated implementation of a protocolized same-day total thyroidectomy program in a high-volume, safety-net academic medical center.

Study design: We conducted a prospective quality improvement study of all patients undergoing total thyroidectomy from January 2023 to December 2024. Patients meeting predefined criteria were offered same-day discharge after 4-hour observation with parathyroid hormone-guided calcium management. Outcomes were compared between same-day and overnight cohorts using chi-square and Mann-Whitney U tests. The primary endpoint was protocol uptake; secondary endpoints included recurrent laryngeal nerve injury, hypoparathyroidism, hematoma requiring evacuation, emergency department visit or readmission, telephone call usage, and postoperative length of stay.

Results: Among 140 patients (55.0% Medicaid; 52.9% non-English speaking; 4.3% experiencing or at risk of homelessness), 51 (36%) were discharged the same day (81% of eligible patients). Adoption increased from 32% to 88% during the study period. Complications were comparable between same-day and overnight cohorts, including temporary recurrent laryngeal nerve injury (2.0% vs 4.5%; p = 0.44), hematoma evacuation (2.0% vs 2.2%; p = 0.91), postanesthesia care unit parathyroid hormone less than 12 pg/mL (25.5% vs 20.2%; p = 0.47), and emergency department visit or readmission (3.9% vs 10.1%; p = 0.19). No same-day patient had hypoparathyroidism at 6 months. Median postoperative hospital time was 5.1 hours (interquartile range 4.7 to 6.3 hours) for same-day discharge vs 22.7 hours (interquartile range 18.8 to 23.9 hours) for overnight observation (p < 0.001).

Conclusions: In a socioeconomically vulnerable population, protocolized same-day total thyroidectomy was safely implemented, achieved high adoption, and substantially reduced hospital use without increased adverse events.