Same-Day Thyroidectomy Outcomes: A Canadian Multi-Center Retrospective Cohort Study
Bibliographic record
Abstract
Abstract Background The American Thyroid Association supports same-day thyroid surgery (SDT) in select patients. In practice, it is common for thyroid surgeons to monitor patients overnight for postoperative complications such as cervical hematoma, recurrent laryngeal nerve injury (RLN) and symptomatic hypocalcemia. We sought to determine the safety profile and predictive factors of adverse postoperative outcomes for SDT based on the experience of three large institutions. Methods A retrospective cohort study was conducted for all thyroidectomies performed at three McGill University tertiary and quaternary care centers in Montreal, Canada between January 1st, 2016 and November 13th, 2020. Patient characteristics were associated with outcomes by bivariate and multivariate analyses. Results A total of 2297 records were surveyed and 1983 patients (1513 females, 470 males) met the inclusion criteria. Amongst them, 603 (30.4%) patients were discharged the same day. The overall postoperative complication rate amongst SDT was 3.6% compared with 10.7% for inpatients (p < 0.0001). Cervical hematoma was not observed in the SDT group, whereas 8 inpatients (0.6%) developed this complication (p = 0.061). RLN injury occurred in 7 SDT (1.2%), compared with 35 (2.5%) inpatients (p = 0.050). Symptomatic hypocalcemia occurred in 3 SDT (0.5%) compared with 73 (5.3%) inpatients (p < 0.0001). 36 (6%) 30-day Emergency department (ED) visits were noted for SDT compared to 172 (12.5%) for inpatients (p < 0.0001), and none required readmission or reoperation within that postoperative period. In the multivariate logistic regression analysis, SDT patients were less associated with comorbidities and had a lesser risk to develop symptomatic hypocalcemia (p < 0.0001). SDT patients had lower 30-day ED (p = 0.041) and reoperation (p = 0.037) rates compared with the inpatient group. Conclusion This study demonstrates that SDT are safe in a select group of patients under the care of experienced thyroid surgeons at high volume thyroid surgery centers. SDT can also lead to significant cost savings in a publicly funded health care system. Further exploration is needed to clarify patient profiles most amenable to SDT and inform clinical decision-making.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".