Predictive factors of a hospital length of stay >24 h in patients undergoing total thyroidectomy

ABSTRACT Context: Total thyroidectomy (TT) was once considered high risk, but now it is safe surgery, and trends are moving toward performing it as an outpatient procedure. Aims: The primary endpoint: identify the patients that are at high risk of hospital length of stay (LOS) >24 h. The secondary endpoint is to evaluate the predictive value of postsurgical corrected serum calcium (cCa) and parathormone (PTH) in the development of symptomatic hypocalcemia. Subjects and Methods: This is a retrospective, observational, and analytic study. The population under study were patients ≥≥18 years old undergoing TT in our hospital between January 2017 and June 2022. Statistical significance was considered when P < 0.05. Results: A total of 270 patients were eligible for this study. About 58.5% of patients had a hospital LOS ≤≤24 h. The proportion of patients with anticoagulant therapy, neck drainage, and postoperative complications such as neck hematoma, hypocalcemia, or recurrent laryngeal nerve injuries was significantly higher in the hospital LOS >24 h group. A higher surgery time was associated with a hospital LOS >24 h. On the other hand, patients with multinodular goiter as a surgical indication had an odds ratio of 0.52 for a hospital LOS >24 h (95% confidence interval: 0.29; 0.95, P = 0.032). The predicted value of cCa and PTH serum levels were tested, and a threshold of cCa ≤≤8.27 mg/mL and PTH ≤≤10.15 pg/dL were found for the development of symptomatic hypocalcemia. Conclusions: The independent risk factors associated with a hospital LOS >24 h were anticoagulant therapy, intraoperative drain placement, other complications such as nausea, vomiting, or pain, postsurgical laboratory, and symptomatic hypocalcemia. A postoperative cCa ≤ 8.27 mg/mL and a postoperative PTH ≤≤10.15 pg/dL are correlated with the development of symptomatic hypocalcemia.