Analysis Of Factors Affecting Postoperative Length Of Stay After Thyroid Surgery

Purpose:To collect clinical case data of 826 patients treated with thyroid surgery in a tertiary care hospital in Guangzhou,to analyze the influencing factors of their postoperative length of stay(PLOS),and to provide theoretical basis and discuss corresponding measures for optimizing the perioperative management of patients and shortening the postoperative length of stay.Methods:The clinical data of 826 patients undergoing thyroid surgery who met the inclusion and exclusion criteria and were seen in a tertiary hospital in Guangzhou City between January 1,2021 and July 30,2022 were retrospectively analyzed,and the patients’ general information:including gender,age,and body mass index(BMI);preoperative variables:including American Society of Anesthesiologists(ASA)score,preoperative major comorbidities(including hypertension,diabetes,cardiac disease,pulmonary disease);perioperative variables:including operating time,first day postoperative drainage,postoperative adverse events and other factors that may have an impact on the patient’s PLOS.Patients were divided into a normal PLOS recovery group(PLOS<75th PLOS)and a prolonged postoperative length of stay(PPLOS)group(PLOS≥75th PLOS).These factors that may affect patients’ PLOS were subjected to univariate analysis to screen out the relevant factors affecting patients’ PLOS,and factors with P<0.2 in the univariate analysis were used as independent variables for multiple logistic regression analysis to determine the specific effect of each factor on patients.The results of the multivariate logistic regression analysis were further used to explore the causes and optimization measures of the influence of each factor on patients’ PLOS.Results:A total of 826 patients who met the inclusion and exclusion criteria were included in the study,including 222 males(26.9%)and 604 females(73.1%).The patients were aged 18～78 years,with a mean age of(44.9±12.6)years.the PLOS was 2～15 days,with a mean PLOS of(2.76±0.42)days and a 75th PLOS of 3 days.according to their 75th PLOS,the patients were divided into the PLOS normal recovery group(PLOS<3 days)and the PPLOS group(PLOS≥3 days).There were 441 patients(53.4%)in the normal recovery group and 385 patients(46.6%)in the PPLOS group.By multiple logistic regression analysis,ASA grade Ⅱ and above(P=0.004),total thyroidectomy(P<0.001),clearance of lymph nodes in the central and lateral cervical regions(P<0.001),drainage>72.5 ml on the first postoperative day(P<0.001),and operative time>92.5 min(P<0.001)were significant influencing factors for patients’ PPLOS.PPLOS was 3.803 times more likely to occur in patients with ASA grade Ⅱ or higher than in patients with ASA grade Ⅰ.PPLOS was 0.448 times more likely to occur in patients who underwent total thyroidectomy than in those who underwent unilateral lobectomy and isthmus;PPLOS was 10.643 times more likely to occur in patients with lymph node dissection in the central and lateral cervical regions than in those without lymph node dissection.PPLOS was 2.098 times more likely to occur in patients with drainage>72.5 ml on the first postoperative day than in patients with drainage ≤72.5 ml on the first postoperative day;PPLOS was 4.380 times more likely to occur in patients with operative duration>92.5 min than in patients with operative duration<92.5 min;PPLOS was more likely to occur in patients with lumpectomy than in patients with lumpectomy.PPLOS was 8.635 times more likely in patients who underwent lumpectomy than in those who underwent non-lumpectomy surgery.Conclusion:ASA classification≥ grade Ⅱ,total bilateral thyroidectomy,clearance of lymph nodes in the central and lateral cervical regions,drainage>72.5 ml on the first postoperative day,duration of surgery>92.5 min,and lumpectomy are independent influencing factors for the occurrence of PPLOS after thyroid surgery.We should recognize and take note of these significantly associated factors and take appropriate preventive and management measures to optimize the factors that can be improved in order to achieve shorter patient hospitalization and lower medical costs,while using the non-optimizable associated factors in patient preoperative education and postoperative rehabilitation programs.