MON-401 Identification of Patient Factors Associated with Extended Stay Following Total Thyroidectomy: A NSQIP Study

Abstract Disclosure: S. Moronta: None. K. Kumar: None. K. Thompson: None. S. Vargas-Pinto: None. X. Dong: None. Background: Thyroid surgery has evolved from a procedure with an astonishingly high mortality rate to one nearing zero. These surgeries have traditionally been performed in the inpatient setting requiring hospitalization, however, since the 2013 American Thyroid Association (ATA) consensus statement, there has been a trend toward abbreviated stays and outpatient thyroidectomies. Our objective was to analyze patient factors associated with greater than one day postoperative hospitalization utilizing the American College of Surgeons National Surgical Quality Improvement Project (NSQIP) data. To our knowledge, this is the first study to elucidate patient specific factors that may predict success with one day stay versus extended stay thyroidectomies. Methods: We identified adult patients who underwent elective total thyroidectomy using NSQIP data from 2016 to 2022. Patients were categorized into “short stay” if they underwent ambulatory surgery or if they required one overnight stay. “Extended stay” was defined as those patients who required hospitalization for more than two midnights. Patients with unknown discharge status, nonelective surgery, or those who were already inpatient were excluded. Extent of surgery, primary indication, patient demographics, and postoperative outcomes were compared between our two cohorts. Results: We identified 57,481 patients who underwent total thyroidectomy, of which 47,468 (82.6%) had a short stay and 10,013 (17.4%) had an extended stay. Those who had extended stays tended to be more functionally dependent, have more diabetes, COPD, CHF, smoking history, dialysis requirement, and disseminated cancer. Most patients in both cohorts underwent resection for malignancy, however, the proportion was higher in those with extended stay versus short stay (49.8% vs 39.0%, p<0.001). They also had more extensive surgery with more patients undergoing concurrent neck dissection in the extended stay group compared to the short stay group (31.3% vs 17.5%, p<0.001). Those with extended stay also had significantly longer operative times, unplanned readmissions, reoperations, surgical site infections, neck hematomas, drains, and hypocalcemia. The average length of extended stay was 3.8 ± 5.0 days. Conclusion: Most patients undergoing total thyroidectomy were discharged same-day or the day following. Those requiring extended hospitalizations tended to have more comorbidities, more extensive surgery, and more postoperative complications likely related to surgery rather than their underlying comorbidities. While outpatient, short stay thyroidectomies cannot be generalized for every patient, careful selection based on both preoperative and intraoperative factors can be used by surgeons to predict the postoperative course. Presentation: Monday, July 14, 2025