Day Case Hemithyroidectomy: The Scottish Experience

Abstract

Objectives: Analyze our new patient pathway that practices day-case hemithyroidectomy. Methods: Prospective re-audit of patients undergoing primary hemithyroidectomy over 2 years (January 2010-January 2011) and compared it to the first cycle in January 2008-January 2009. Procedures were done by a single surgeon and anaesthetist in a district general hospital. Drains were never used. In the latest audit cycle, all patients underwent standardized anaesthesia and surgical procedures, including pain and nausea management. Patients completed questionnaires at discharge and follow-up 1-2 weeks postoperatively. Hospital stay, complications, and patient satisfaction scores were recorded. Results: The first cycle (54 patients) demonstrated that a third of patients stayed at least 1 night and two thirds stayed 2 nights or more. Following a new protocol, the latest audit cycle (62 patients) demonstrated a 75% day-case rate (P < 0.0001). 98% of day-case patients were happy (questionnaire scoring 8/10 or greater) to be discharged on day of surgery. Of the 25% who stayed overnight, 50% had surgery in the afternoon compared to 21% in the day-case group (P =0.015). 80% of all patients did not need opioid analgesia. 5% had problems with postoperative pain and nausea and were likely to stay overnight. There were no readmissions. Subjective and objective patient experience data will be discussed as well as our hemithroidectomy patient pathway. Conclusions: Successful day case hemithyroidectomy relies on preoperative counseling, specific anaesthesia techniques, meticulous surgery. and careful patient selection. Day case hemithyroidectomy can be safely undertaken in the vast majority and is highly desirable by patients.