Routine outpatient thyroid surgery cannot be recommended

Abstract

Introduction: More than 1,100 thyroid operations are performed annually in Denmark. The major concern regarding outpatient thyroid surgery (OTS) is post-thyroidectomy bleeding (PTB), which may cause compression of the trachea and compromise respiration. We aimed to explore the incidence of PTB and the exact timespan from surgery to PTB, and to identify risk factors for PTB in order to discuss whether OTS can be considered safe.

Methods: Data from the Ear-Nose-Throat Department, Aarhus University Hospital, covering the period from January 2001 to August 2013 were collected from the THYRKIR database, and the medical records of patients with PTB were reviewed.

Results: A total of 42 (2.8%) patients were re-operated due to PTB. Multivariate logistic regression analysis identified male gender (odds ratio (OR) = 1.85) and thyrotoxicosis (OR = 2.68) as risk factors for PTB. PTB occurred within 6 h of surgery in 63% of cases, between 6 and 24 h in 25% of cases, and more than 24 h after surgery in 13% of cases. One patient required urgent reoperation due to acute respiratory insufficiency.

Conclusion: Although a rare event, PTB is potentially life-threatening, and unselected routine OTS cannot be considered safe. Until more studies have been conducted on the selection of patients suitable for OTS, we recommend, as a minimum, that patients are observed for at least 6 h after surgery and subsequently stay at a nearby hospital hotel until discharge 16 to 24 h postoperatively.

Funding: not relevant.

Trial registration: The study was approved by the Danish Data Protection Agency (1-16-02-170-14).