Is same-day total thyroidectomy feasible in the Swedish healthcare system?

Abstract Introduction Traditionally, total thyroidectomy is performed as an inpatient procedure due to concerns of postoperative bleeding and hypocalcemia. However, several studies show that same-day thyroidectomy is safe. On April 1, 2024 we introduced same-day discharge after total thyroidectomy at Sahlgrenska University Hospital. This report presents a one-year retrospective analysis with primary endpoint postoperative complications including bleeding, recurrent laryngeal nerve injury and hypoparathyreoidism. Method Data was collected from the hospital healthcare data dashboard for the time period April 1, 2024 to March 31, 2025 and from SQRTPA from April 1 to Dec 3, 2024. All patients scheduled for total thyroidectomy were evaluated for a same-day procedure. Exclusion criteria were risk of sternotomy, lateral and/or bilateral central lymph node dissection, anticoagulantia treatment, language barriers, living alone, > 40 minutes to an emergency hospital, significant comorbidity, age <18. Result During this period, 166 total thyroidectomies were performed, including 72 with same-day discharge. Two patients were converted to overnight observation due to increased bleeding risk identified during surgery. In SQRTPA 87 thyroidectomies were registered, of which 37 were done in a same-day setting. indications for surgery were thyreotoxicosis (86%), malignancy (11%), and compression symptoms (3%). None of the same-day patients required re-operation due to bleeding or were readmitted. None had nerve damage, but nine had transient hypoparathyroidism treated with vitamin D and p.o. calcium for 21 days (median; range 2-43). One patient previously operated with gastric bypass had persistent hypoparathyreoidism. Discussion This analysis demonstrated that same-day thyroidectomy is a safe procedure in selected patients.