(300) Drain Utilization and Postoperative Outcomes Following Thyroidectomy: An Age-Stratified NSQIP Analysis

Introduction: Jackson-Pratt (JP) drains are commonly used following thyroidectomy to monitor for postoperative bleeding and fluid accumulation, though prior studies have questioned their routine use in mixed-age populations. However, age-stratified outcomes have not been well characterized. This study evaluated whether drain utilization and postoperative outcomes following thyroidectomy differ in patients ≤21 years compared with older adults using a national surgical database.

Methods: A retrospective analysis was conducted using the 2021 National Surgical Quality Improvement Program (NSQIP) Thyroid-Specific Dataset. Patients were dichotomized by age (≤21 years vs. >21 years). Outcomes included drain utilization, postoperative hypocalcemia prior to discharge, hypocalcemia within 30 days, clinically severe hypocalcemia, recurrent laryngeal nerve dysfunction, neck hematoma, and postoperative length of stay. Multivariable logistic regression was used to evaluate associations between age and outcomes while adjusting for extent of surgery and neoplastic pathology.

Results: A total of 7,233 patients were included, of whom 112 (1.5%) were ≤21 years old. Neoplastic pathology was equally distributed between age groups (63% vs. 63%, p>0.90). There was no significant difference in drain utilization (20% vs. 25%, p=0.20) or calcium supplementation (56% vs. 56%, p=0.90). Patients >21 years had higher rates of recurrent laryngeal nerve dysfunction (6.2% vs. 1.8%, p=0.05). After adjustment, age was not independently associated with drain use, postoperative complications, or length of stay.

Conclusions: In this national cohort, age ≤21 years was not associated with differences in drain utilization or postoperative outcomes. Extending prior work questioning routine JP drain use, these findings suggest that evidence supporting selective drain use following thyroidectomy in mixed-age populations is applicable to pediatric and young adult patients, and age alone should not guide postoperative drain management.