Optimising same day discharge hemithyroidectomy: defining outcomes, unplanned admissions and patient experience.

Background: There is increasing emphasis on day-case hemithyroidectomy in the UK, with the national NHS/Get-it-right-first-time (GIRFT) recommending 30% zero-night stay rate. Buckinghamshire Healthcare Trust currently achieves >70% zero-night stay rate. This study profiles successfully treated day-case patients, evaluates reasons for unplanned admissions, complication rates and patient satisfaction, offering insights for units seeking to expand day-case practice.

Methods: This is a retrospective cohort review from 2020 to 2024 of patients undergoing hemithyroidectomy treated by two surgeons: one with over a decade of day-case experience and one adopting the practice in 2021.

Results: Of 336 patients (mean age 51±15 years, male:female 1:4), 283 (84%) were discharged on the same day with planned overnight admissions (37 patients, 11%) were primarily older (62 versus 50 years, p<0.05), more often American Society of Anesthesiologists (ASA) grade 3 (p=0.05), with a trend towards larger gland size, without correlation in either group to surgeon experience. Reasons for unplanned admissions in 14 patients (4%) were: anaesthetic concerns (n=3), intraoperative bleeding (n=2), large glands (n=2) and combined others, with all stays <48h. There was no correlation between unplanned admissions and patient age, ASA status or surgical indication. No hemithyroidectomy resulted in postoperative neck hemorrhage or return to theatre. More than 80% of patients surveyed would choose same-day discharge hemithyroidectomy over an inpatient stay, with all of respondents reporting adequate pain control.

Conclusions: With robust protocols and appropriate patient selection, high rates of day-case hemithyroidectomy are achievable, in alignment with a high rate of patient satisfaction. Unexpected admissions lack clear predictors.