Same-day thyroidectomy: a review of practice patterns and outcomes for 1,168 procedures in New York State.

BACKGROUND: There has been a shift of procedures from the inpatient to the outpatient setting. Same-day thyroidectomy (SDT) has been reported in high-volume single-institution series, but few studies have evaluated its widespread use.
METHODS: Patients undergoing thyroidectomy for benign and malignant thyroid disease were abstracted from the 2004 New York State inpatient (SID) and ambulatory surgery (SASD) databases. SDTs were discharged on the same day as their surgery. Patient and provider (surgeon and hospital volume) characteristics were associated with outcomes, including probability of SDT versus hospital admission and 30-day rehospitalization, by bivariate and multivariate analyses.
RESULTS: A total of 6,762 thyroidectomies were identified; 17% (1,168) were SDTs. Patients undergoing SDT compared to thyroidectomy with admission were more often white (80 vs. 65%, P < 0.001), with private insurance (80 vs. 70%, P < 0.001) and fewer comorbidities (96 vs. 89% with Charlson scores of none/low, P < 0.001). SDT was performed more often by high-volume surgeons (48 vs. 31%, P < 0.001) and at high-volume hospitals (61 vs. 35%, P < 0.001). Rehospitalization rates of 1.4 and 2.4% were observed for SDT and inpatient thyroidectomy, respectively (P = NS). In multivariate analysis, thyroidectomy by a high-volume surgeon was associated with a higher chance of same-day discharge (odds ratio = 2.3, P < 0.001).
CONCLUSION: Nearly 20% of thyroidectomy patients undergo SDT in New York State. They have different demographic and clinical characteristics than patients undergoing thyroidectomy who are admitted. There seem to be a few high-volume surgeons and centers with extensive SDT experience. More research is needed to explore optimized patient triage and patterns of referral to centers of excellence.