Complications and risk factors related to the extent of surgery in thyroidectomy. Results from 2,043 procedures

Abstract

OBJECTIVE: To evaluate the rate of complications and the risk factors in relation to the extent of surgery in patients undergoing thyroidectomy in a tertiary university center. DESIGN: Data were collected retrospectively from 2,043 consecutive patients who underwent thyroid surgery for various thyroid diseases at the University Hospital of Patras, Greece, between January 1996 and December 2007. recurrent laryngeal nerve palsy (rLNP) and hypoparathyroidism were set as the primary end points, while hematoma and wound infection were set as the secondary endpoints. rESULTS: Total, near-total and subtotal thyroidectomy was performed in 1,149, 777 and 117 patients, respectively. Transient rLNP occurred in 34 (1.6%) and permanent in 19 (0.9%) patients. Multivariate logistic regression analysis showed that extended resection (Or-odds ratio-1.6), Graves' disease (Or 2.7), thyroiditis (Or 2.1), recurrent goiter (Or 2.3) and thyroid malignancy (Or 1.7) were all independent risk factors for transient rLNP, whereas Graves' disease (Or 2.2) and recurrent goiter (Or 1.7) emerged as independent risk factors for permanent rLNP. The rates of transient and permanent hypoparathyroidism were 27.8% and 4.8%, respectively. Multivariate analysis for transient hypoparathyroidism revealed that the extent of surgical resection (Or 2.2), Graves' disease (Or 2.1), recurrent goiter (Or 1.7), female gender (Or 1.5) and specimen weight (Or 1.6) were independent predictors. However, the extent of surgical resection (Or 2.7), Graves' disease (Or 1.8), recurrent goiter (Or 1.5) and malignant disease (Or 1.5) were independent risk factors for permanent hypoparathyroidism. Postoperative wound infection and hematoma occurred in 6 (0.3%) and 27 (1.3%) patients, respectively. No correlation was observed between wound infection or postoperative hemorrhage and the extent of surgery. CONCLUSIONS: Despite the higher morbidity, total thyroidectomy is emerging as an attractive surgical option even for benign thyroid disease due to the risk of subclinical (occult) malignancy, the possibility of goiter relapse as well as of the increased risk of complications following reoperation.

Recurrent laryngeal nerve injury in thyroid surgery: a review

“…These findings are supported in several other smaller studies, with reported rates for RLNP in thyroid cancer operations ranging from 2% to 50%. 1,6,7,13,21 Our data confirm increased incidence of temporary and permanent RLNP in cancer versus benign disease surgery. The incidence of permanent and transient RLNP in thyroid cancer surgery was 0.28% and 1.82%, respectively.…”

Randomized clinical trial of ultrasonic scissorsversusconventional haemostasis to compare complications and economics after total thyroidectomy (FOThyr)

“…Large case series suggest that rates of these complications are: haematoma, 1·2–2·1 per cent1, 2, 3, 4; transient hypoparathyroidism, 6·4–35·2 per cent1, 2, 4, 5, 6; permanent hypoparathyroidism, 0·9–6·3 per cent1, 2, 3, 5, 6; transient RLN injury, 0·36–3·9 per cent1, 2, 3, 4, 5; and permanent RLN injury, 0·7–1·4 per cent1, 2, 3, 5. Short‐term complications increase length of stay in hospital, the number of consultations, diagnostic tests and treatments needed, and overall cost.…”

Percentage Decline of Parathyroid Hormone Level is a Predictor for Post-thyroidectomy Symptomatic Hypocalcemia

“…Laboratory tests including perioperative PTH level, total calcium, ionized calcium, and phosphorus level were evaluated (3,(9)(10)(11)(12)(13)(14)(15)(16). In most of these studies, postoperative serum PTH was recommended as the most powerful predictor for post-thyroidectomy hypocalcemia, with a sensitivity ranging from 64% to 100% and a specificity ranging from 72% to 100%.…”