Do Germans keep patients too long in hospital? A prospective randomized trial

Abstract

Cost-effectiveness reduces hospital stay for all patients with thyroid surgery but lacks information on medical comparability and patients' fulfilled expectations. The aim of this study was to assess if a hospital stay of 2 days after thyroid surgery had a negative influence on the medical quality or on health-related quality of life. In a controlled prospective randomized trial with 238 patients, a postoperative hospital stay of 2 days was compared to one longer than 2 days. The postoperative medical investigation included serum calcium levels, laryngeal nerve function, and suction drainage volume. Health-related quality of life was assessed on the day of admission before the operation and again 14 days after discharge. Fourteen days after discharge patients were also asked about their subjective health. Despite the study design, it was necessary, for ethical reasons, to let the patients decide when to leave the hospital. In the 2-day study group, 56.6% of the patients preferred hospitalization for more than 2 days (most choosing 3 days). Medical reasons were hyperthyroidism (p < 0.02) and postoperative hypocalcemia (p < 0.03). In the control group 28% left the hospital after 2 days. Only 35% of the patients left the hospital at the second postoperative day, but 60% of these patient supported this shorter hospitalization. Health-related quality of life and self-rated health was significantly higher in patients leaving the hospital on the second postoperative day. A 2-day hospital stay after thyroid surgery is possible and does not show medical or health-related quality of life disadvantages in patients with an uncomplicated postoperative course who consider themselves healthy.