Impact of completion thyroidectomy timing on post-operative complications: a systematic review and meta-analysis

Abstract

Background: Despite a number of studies, the optimal timing of completion thyroidectomy is still controversial. This systematic review and meta-analysis aims to compare the outcomes of early versus delayed completion thyroidectomy regarding post-operative complications. Methods: We performed a systematic review in electronic databases including: bumped, Scopus, Medline and Google Scholar to identify relevant studies. Eligibility criteria included studies comparing the outcomes of early versus delayed completion thyroidectomy with no language restriction. Publication bias was assessed by funnel plot, and Heterogeneity was assessed using I 2 statistic. Finally, pooled odds ratios (OR) with a 95% confidence interval (CI) was reported for comparing the overall complications rate. Results: Eventually 7 studies were included. Delayed completion thyroidectomy was found to be associated with significantly lower rates of post-operative complications (OR =1.55; 95% CI, 1.00-2.42; Z=1.95; P=0.05) with low heterogeneity (I 2 =0%, P=0.55), and low risk of publication bias. The rate of transient hypocalcemia and persistent hypocalcemia were 8.97% and 1.52% in early completion thyroidectomy group, and 8.2% and 0.72%, in delayed completion thyroidectomy group. Transient vocal cord paresis occurred in 5.38% of the early CT group versus 3.27% in the delayed CT group. Conclusions: This review is the first to summarize the outcome of early verse delayed completion thyroidectomy. The result of our systematic review and meta-analysis suggest that delayed completion thyroidectomy is associated with lower rate of post-operative complications compared to early completion thyroidectomy.

Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy

“…In our unit, patients with protracted hypoparathyroidism, who recovered the parathyroid function, did receive significantly higher doses of calcium salts (2.75 vs. 2.12 g/day of Ca ++ ) and calcitriol (0.63 vs. 0.38 mcg/day) at the time of hospital discharge than those patients developing permanent hypoparathyroidism [ 14 ]. To further support an aggressive medical treatment of postoperative parathyroid failure, Bin Saleem et al [ 97 ] have reported that delayed (>90 days) completion of total thyroidectomy (usually performed after the diagnosis of cancer is made in the initially resected lobe) carries a lesser risk of hypoparathyroidism than early (7–90 days) redo surgery. This may be explained by the contralateral normal parathyroid glands splinting the pair potentially injured on the first operated side.…”

Robotic Completion Thyroidectomy via the Bilateral Axillo-Breast Approach

“…However, some studies have reported that the interval from the initial surgery to completion thyroidectomy does not have an effect on the rate of postoperative complications after completion thyroidectomy [ 25 , 26 ]. Additionally, in a systemic review and meta-analysis by Bin et al [ 27 ], delayed completion thyroidectomy (after 90 days) was associated with a lower rate of overall surgical complications than early completion thyroidectomy (7 to 90 days) (OR = 1.55; 95% CI, 1.00–2.42; z = 1.95, p = 0.05). Therefore, the optimal surgical timing of completion thyroidectomy remains unclear.…”

Case for staged thyroidectomy

“…While some studies demonstrated that the timing of a completion thyroidectomy does not affect the complication rate, 62 others have shown that a delayed procedure has a lower complication rate. 63 Regardless of the controversy of when to operate, completion thyroidectomy should be performed based on the relevant pathology, physical findings (RLN function), and parathyroid function. 64 There has been some interest in ablation of the contralateral lobe using a larger dose of RAI in highly selected patients who definitely require completion thyroidectomy.…”

“…A patient undergoing a partial thyroidectomy in which the ipsilateral RLN becomes injured has the option of foregoing additional surgery (completion thyroidectomy) to avoid the risk of needing a tracheostomy. Influencing this decision following a partial thyroidectomy is the possibility that the RLN can regain its function spontaneously, thus permitting a completion thyroidectomy.While some studies demonstrated that the timing of a completion thyroidectomy does not affect the complication rate, 62 others have shown that a delayed procedure has a lower complication rate 63 . Regardless of the controversy of when to operate, completion thyroidectomy should be performed based on the relevant pathology, physical findings (RLN function), and parathyroid function 64 …”