M Anas, G Abdelhalim, R H Al-Deen, M Choudhry, S Germain, B Kaur, T Masters, M Suseeharan, Z Siddiqui, A Al-Lami
Implementation of a pragmatic, checklist-guided pathway facilitated safe same-day discharge in a subset of patients during early implementation. However, it did not achieve the 90% target as per the GIRFT recommendations. An algorithm alone is insufficient, because surgeon-specific drain practice and theatre scheduling must be addressed if national day-case targets are to be approached.
INTRODUCTION: Advancements in minimally invasive techniques, coupled with structured perioperative protocols, have rendered same-day discharge following parathyroidectomy increasingly viable. National recommendations, including those from the Getting It Right First Time (GIRFT) national programme, propose that 90% of procedures for primary hyperparathyroidism be performed as day cases; however, uptake remains variable across UK centres.
METHODS: A retrospective audit of 107 consecutive parathyroidectomy cases (October 2019-October 2022) informed the development of a standardised day-case pathway across a multi-site National Health Service trust. The pathway incorporated defined eligibility criteria, prioritisation on morning operating lists, expedited postoperative biochemical assessment and protocolised discharge procedures. Data from the subsequent implementation phase (October 2023-June 2025) were collected prospectively. The audit loop was closed through a re-audit from July 2025 to February 2026 after emphasis on more judicious drain usage.
RESULTS: In the retrospective baseline cohort, only 7% of patients were discharged within 24h. In the initial implementation cycle, 22 patients underwent surgery under the pathway and 11 (50.0%) achieved same-day discharge. Drain insertion was the principal modifiable barrier identified in the first cycle. In the re-audit, 16 were suitable for day-case surgery and 5 of these (31.3%) were discharged the same day. Drain use fell to 1 case (6.3%). However, same-day discharge remained below target because logistical factors, particularly afternoon surgery or late list starts, accounted for most failed discharges among suitable patients. Overall there were no 30-day readmissions, re-operations for haematoma and 2 cases with significant hypocalcaemia requiring supplementation orally leading to overnight stays.
CONCLUSIONS: Implementation of a pragmatic, checklist-guided pathway facilitated safe same-day discharge in a subset of patients during early implementation. However, it did not achieve the 90% target as per the GIRFT recommendations. An algorithm alone is insufficient, because surgeon-specific drain practice and theatre scheduling must be addressed if national day-case targets are to be approached.