Should Thyroid Lobectomy Be Performed as a Day-Case Procedure? A Single-Centre Retrospective Audit.

Abstract

Introduction The British Association of Endocrine and Thyroid Surgeons (BAETS) published guidance in 2012 advising against day-case thyroid lobectomy due to the unpredictable risk of post-operative haematoma. Due to the increasing pressures the National Health Service (NHS) faces, a position statement was released by BAETS in 2020 highlighting their support of day-case thyroid lobectomy in specific low-risk cases with the introduction of appropriate local protocols. Objective We aimed to assess post-operative complications of thyroid lobectomy at University Hospitals Bristol and Weston NHS Trust (UHBW), a tertiary centre for Otolaryngology, to consider the feasibility and safety of day-case surgery in our unit. Methods We conducted a retrospective audit of 140 elective thyroid lobectomy cases identified in the period of January 2017 to December 2018 at UHBW. Inclusion criteria included no previous thyroid surgery or major head and neck surgery, elective thyroid lobectomy procedure only, and surgery performed at UHBW by otolaryngology or maxillofacial teams. Exclusion criteria included emergency hemithyroidectomy; hemithyroidectomy as part of another procedure; and completion thyroidectomy. Results A total of 140 elective thyroid lobectomy procedures were performed between January 2017 and December 2018. Of them, 125 cases met inclusion criteria, and 15 cases were excluded: two emergency hemithyroidectomy, three incorrect coding, four hemithyroidectomy as part of another head and neck procedure, and six completion thyroidectomy. Mean age was 51.9 years (range: 20-88 years), with 30 (24.0%) male cases and 95 (76.0%) female cases. Mean in-patient stay was 1.4 days (range: 0-19 days), and mean hours in hospital were 34 hours. Two (1.6%) cases were discharged on the same day of their operation. Post-operative complications included five (4%) cases of post-operative haematoma, four (3.2%) cases of unilateral vocal cord palsy, one (0.8%) case of pneumonia, and three (2.4%) cases of wound infections. From those cases that developed post-operative haematoma, 80% (n=4/5) developed less than 24 hours after the procedure. One (20%) case of post-operative haematoma developed on day 6 after their procedure and required readmission for re-operation. Conclusion The unpredictable nature of post-operative haematoma poses a significant risk to patients and medicolegal implications. Our findings suggest that there were no predictable risk factors amongst our patient cohort and therefore day-case thyroid lobectomy should be avoided. Further research is required to identify low-risk patients who could benefit from day-case surgery.