This study examined the safety and outcomes of matched groups of patients, undergoing either inpatient thyroid / parathyroid surgery or being discharged within eight hours of surgery. There were 2,362 patients in each group who were matched by a ‘propensity score’ that was calculated based on factors that may affect surgical outcome, including surgeon experience, comorbidities, thyroid pathology and procedure types. The rates of mortality, reattendance / readmission, haematoma, hypocalcaemia, vocal cord palsy, and other complications, were examined retrospectively. Prior to the application of the matching model, the rates of all complications were lower among patients undergoing outpatient surgery.
Once ‘propensity score’ matching was applied, there was no significant difference in complications between the two groups. The study demonstrates the feasibility and safety of outpatient thyroid and parathyroid surgery, albeit in the USA where day-case surgery is highly favoured.
This practice would represent a significant change if applied in the UK, but should be borne in mind in light of large studies with robust methods. The authors rightly point out a progressive change towards outpatient operating over time, which could have skewed results in favour of the eight-hour-stay model. The design of the study permits a large-scale analysis, but introduces a degree of reporting bias that is difficult to quantify.
