Type of publication:
Journal article
Author(s):
*Crossdale M.; *Walkden G.; *Hari C.
Citation:
Ambulatory Surgery. Conference: British Association of Day Surgery Annual Conference. London United Kingdom. 32(3) (pp 185), 2026. Date of Publication: 01 Jul 2026.
Abstract:
Introduction The day case potential of total thyroidectomy has been limited by three primary risks: post-operative haemorrhage, recurrent laryngeal nerve injury with subsequent airway embarrassment and symptomatic hypocalcaemia. In response to rising elective backlogs, transitioning to a day-case model offers significant resource optimisation and improved patient satisfaction. We present the initial outcomes of a pilot day-case total thyroidectomy pathway within an NHS Trust. Methods Five consecutive patients underwent total thyroidectomy under a standardised day case protocol. The pathway prioritised: * Patient selection and education: strict surgical, anaesthetic and social criteria, informed consent and education around day case management. * Pre-operative optimisation: prophylactic loading with oral calcium and alfacalcidol. * Surgical strategy: meticulous surgical strategy (advanced bipolar techniques, haemostatic adjuncts, and Valsalva manoeuvres) to avoid drain insertion. * Biochemical monitoring: immediate post-operative PTH and serum calcium measurement. * Intended same day discharge: minimum postoperative stay 6 hours and until 20:00. * Post-operative safety net: discharge on a calcium/ alfacalcidol regimen with day one telephone follow-up and mandatory 48-hour biochemical review. Results The pilot achieved a 100% same-day discharge rate (n = 5). No post-operative haemorrhages or hematomas occurred. One patient was readmitted following the 48-hour review for mild hypocalcaemic symptoms, requiring one night of oral optimisation. The remaining four patients remained asymptomatic with stable biochemistry. Conclusion Preliminary results suggest day-case total thyroidectomy is feasible for selected patients when supported by a pathway that mitigates post-operative anaesthetic and surgical risks. While hypocalcaemia remains a concern, prophylactic supplementation and structured follow-up facilitate safe management in an ambulatory setting.
