Background: Length-of-stay (LOS) after various surgical procedures varies greatly between centres and countries. In the US there is increasing tendency towards day-case thyroid and parathyroid surgery but their model of care cannot be easily extrapolated. In the UK the average LOS for such operations is 34 days.
Methods: Retrospective review of data retrieved from hospital-based software regarding the surgical activity during a decade in a large University hospital. Data was analysed on 3-years intervals (20002002, 20032005, 20062008, 20092010).
Results: During January 2000June 2010 a total of 1934 patients underwent thyroid (n=1264) and parathyroid (n=670) surgery. Gender ratio (1339 F:595 M) and age of patients (54±17 years, range 1289 years) did not vary significantly during the study period. Indication for surgery was hyperthyroidism (n=192), malignancy (n=239), multinodular goitre (n=833), primary hyperparathyroidism (n=670). Main operating surgeon was a Consultant (n=2) or an advanced surgical trainee (n=3).
During each time period, LOS decreased from 2.8±2.5 to 1.9±2.5 days. The percentage of patients discharged on the day of their operation increased progressively from 20 to 45% for thyroid surgery and from 30 to 75% for parathyroid surgery. Readmission rate was 0.8%. There was no peri-operative mortality. Introduction of routine short-term hypocalcaemia prophylaxis (2000), scan-directed parathyroidectomy (2003), Harmonic scalpel (2005) and local-anaesthetic parathyroid surgery (2009) had impacted on LOS during the study period. At the present time patients expect to be discharged on the day of surgery for parathyroid surgery and on postoperative day 1 after total thyroidectomy for benign disease. According to official DOH figures the current LOS for our unit is the shortest in the UK.
Conclusion: Reducing LOS for thyroid and parathyroid surgery has been facilitated by pioneering acceptance of new technologies and by a critical mass effect that allows a confident multidisciplinary approach with safe outcomes that can complement likely financial benefits (though not formally assessed in this study).