Low Readmission and Expanding Same-Day Discharge After Total and Completion Thyroidectomy During Use of a PACU PTH–Guided Supplementation Pathway

BackgroundOutpatient total and completion thyroidectomy is increasingly feasible, but long-term institutional data describing simultaneous expansion of same-day discharge and maintenance of low readmission are limited. We describe 14-year outcomes using a PACU parathyroid hormone (PTH)-guided calcium and calcitriol supplementation pathway.MethodsRetrospective single-institution cohort of total and completion thyroidectomies (2010-2023) analyzed across three complementary data sources: an NSQIP case-level cohort (N = 1111) for readmission, length of stay, and discharge timing; institutional NSQIP Semiannual Report (SAR) data (N = 1393) for hypocalcemia-related readmission; and the NSQIP thyroidectomy-targeted module (N = 766) for postoperative hypocalcemia. Institutional NSQIP observed-to-expected (O/E) ratios were reviewed as contextual benchmarking.ResultsSame-day discharge (LOS = 0 days) rose from <5% before 2017 to 60.0% in 2022 and 70.9% in 2023, and short-stay discharge (LOS ≤1 day) exceeded 90% annually from 2019 onward. Across the full period, 30-day all-cause readmission was 1.71% (95% CI: 1.10-2.66%). Hypocalcemia requiring readmission occurred in 1.4% of the SAR cohort and accounted for 67.9% of readmissions. Postoperative hypocalcemia was documented in 7.4% of the module subset (95% CI: 5.8%-9.5%), with clinically significant events in 4.0%. The mean institutional NSQIP O/E ratio was 0.93 (range 0.74-1.24).DiscussionAcross a 14-year cohort, same-day discharge after total and completion thyroidectomy expanded while 30-day readmission and clinically significant hypocalcemia remained low. These findings support the feasibility of outpatient thyroidectomy within a standardized PACU PTH-guided supplementation pathway; because PACU PTH values were unavailable, prospective studies are needed to determine whether the pathway independently influenced these outcomes.