Risk of Complications in Patients Undergoing Complete Thyroidectomy. A Retrospective Study
Keywords:
Thyroidectomy, complications undergoing patients, surgery
Abstract
Introduction: The main aim of this study was to determine the influence of surgery on postoperative complications in patients undergoing total thyroidectomy. Methods: Patients diagnosed with goiter and undergoing total thyroidectomy for more than ten years were retrospectively enrolled, and the main study outcomes were postoperative complications. Statistical analysis was done by chi-square and t-test with a p-value <0.05 as significant. Results: A total of 116 patients with goiter were identified (mean age, 45.3 ± 8.75 years, with minimum and maximum age of 23 to 69). The most affected age with goiter resulted in 41-50 years old with 41.4% (95% CI, 37.4 to 45.8%). The majority of patients with goiter were women (85.3%), with a mean age of 47 years. After the thyroid surgery, male patients had significantly higher rates of hospital readmission than females with a risk ratio [RR] of 1.05; 95% CI [0.67–1.52], p-value = 0.02. Either hemorrhage/hematoma occurred in 4.7% and cardiopulmonary and thromboembolic events in 3.1% of the patients undergoing total thyroidectomy. In addition, either hypoparathyroidism was observed in 3.1% and temporary recurrent laryngeal nerve palsy (RLN) in 1.56%. Conclusion: The current study demonstrates that total thyroidectomy is associated with an increased rate of hemorrhagic complications. RLN palsies and hypoparathyroidism are less observed. Male patients undergoing thyroidectomy have higher rates of readmission and ICU admission. Furthermore, male patients revealed higher rates of hemorrhage and wound infection, while hypoparathyroidism or temporary recurrent laryngeal nerve palsy was more frequent among female patients.
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References
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European Scientific Journal, ESJ ISSN: 1857-7881 (Print) e - ISSN 1857-7431
February 2023 edition Vol.19, No.6
www.eujournal.org 89
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10. Dehal, A., Abbas, A., Al-Tememi, M., Hussain, F., Johna, S. (2014). Impact of surgeon volume on incidence of neck hematoma after thyroid and parathyroid surgery: ten years’ analysis of nationwide in-patient sample database. Am Surg, 80(10):948–952. https://doi.org/10.1177/000313481408001008 11. Del Rio, P., Carcoforo, P., Medas, F., Bonati, E., Loderer, T., Koleva Radica, M., & Calò, P. (2021). Adverse events in thyroid surgery: observational study in three surgical units with high volume/year. BMC surgery, 21(1), 352. https://doi.org/10.1186/s12893-021-01353-6 12. Del Rio, P., Rossini, M., Montana, C.M. et al. (2019). Postoperative hypocalcemia: analysis of factors influencing early hypocalcemia development following thyroid surgery. BMC Surg 18 (Suppl 1), 25 https://doi.org/10.1186/s12893-019-0483-y
European Scientific Journal, ESJ ISSN: 1857-7881 (Print) e - ISSN 1857-7431
February 2023 edition Vol.19, No.6
www.eujournal.org 90
13. Grogan, R.H., Mitmaker, E.J., Hwang, J., Gosnell, J.E., Duh, Q.Y., Clark, O.H., Shen, W.T. (2012). A population-based prospective cohort study of complications after thyroidectomy in the elderly. J Clin Endocrinol Metab, 97(5):1645–1653. doi: 10.1210/jc.2011-1162. 14. Hauch, A., Al-Qurayshi, Z., Randolph, G. et al. Total Thyroidectomy is Associated with Increased Risk of Complications for Low- and High-Volume Surgeons. Ann Surg Oncol 21, 3844–3852 (2014). https://doi.org/10.1245/s10434-014-3846-8 15. Haugen, B. R., Alexander, E. K., Bible, K. C., Doherty, G. M., Mandel, S. J., Nikiforov, Y. E., et al. (2016). 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid: official journal of the American Thyroid Association, 26(1), 1–133. https://doi.org/10.1089/thy.2015.0020
16. Hurtado-López, L.M., Zaldivar-Ramirez, F.R., Basurto, Kuba. E., et al. (2022). Causes for early reintervention after thyroidectomy. Med Sci Monit, 8: CR247–50. PMID: 11951065.
17. Lacoste, L., Gineste, D., Karayan, J., et al. (1993). Airway complications in thyroid surgery. Ann Otol Rhinol Laryngol, 102:441–6. DOI: 10.1177/000348949310200607. 18. Lukinović, J., & Bilić, M. (2020). Overview of Thyroid Surgery Complications. Acta clinica Croatica, 59(Suppl 1), 81–86. https://doi.org/10.20471/acc.2020.59.s1.10
19. Narayanan, S., Arumugam, D., Mennona, S., Wang, M., Davidov, T., Trooskin, S.Z. (2016). An evaluation of postoperative complications and cost after short-stay thyroid operations. Ann Surg Oncol, 23(5): 1440–1445. doi: 10.1245/s10434-015-5004-3.
20. Ortega, Beltrá. N., Martínez, Ruiz. de Apodaca. P., Guallart Doménech, F., Cuesta, González. M.T., Dalmau, Galofre. (2022). Postoperative hypocalcaemia predictors after total thyroidectomy. J. Rev Osteoporos Metab Miner, 14(4):131-135. DOI: http://dx.doi.org/10.4321/S1889-836X2022000300006en.
21. Pandey, A.K., Maithani, T., Agrahari, A., Varma, A., Bansal, C.H., Bhardwaj, A., et al. (2015). Postoperative Complications of Thyroid Surgery: A Corroborative Study with an Overview of Evolution of Thyroid Surgery. International Journal of Head and Neck Surgery, 6(4):149-154. DOI:105005/jp-journals-10001-1245.
22. Papaleontiou, M., Hughes, D.T., Guo, C., Banerjee, M., Haymart, M.R. (2017). Population-Based Assessment of Complications
European Scientific Journal, ESJ ISSN: 1857-7881 (Print) e - ISSN 1857-7431
February 2023 edition Vol.19, No.6
www.eujournal.org 91
Following Surgery for Thyroid Cancer. J Clin Endocrinol Metab, 102(7):2543–2551. DOI: 10.1210/jc.2017-00255. 23. Prgomet, Drago and Bilić, Mario and Kovač, Lana and Hutinec, Zdenka and Topić, Iva (2012) Lokalno invazivni papilarni karcinom štitnjače - naša iskustva [Locally invasive papillary thyroid cancer - our experience]. Liječnički vjesnik, 134 (9-10). pp. 266-20. ISSN 0024-3477.
24. S⊘rensen, K.R., Klug, T.E. (2015).Routine outpatient thyroid surgery cannot be recommended. Dan Med J, 62: pii: A5016. 25. Sadowski, S. M., Vidal Fortuny, J., & Triponez, F. (2017). A reappraisal of vascular anatomy of the parathyroid gland based on fluorescence techniques. Gland surgery, 6(Suppl 1), S30–S37. https://doi.org/10.21037/gs.2017.07.10
26. Sahmkow, S.I., Audet, N., Nadeau, S., et al. (2012). Outpatient thyroidectomy: safety and patients’ satisfaction. J Otolaryngol Head Neck Surg, (suppl 1): S1–2. PMID: 22569044.
27. Schwartz, A.E., Clark, O.H., Ituarte, P., Lo, Gerfo. P. (1998). Therapeutic controversy: Thyroid surgery the choice. J Clin Endocrinol Metab, 83:1097–105. doi: 10.1210/jcem.83.4.4740-1. 28. Shen, C., Xiang, M., Wu, H., Ma, Y., Chen, L., & Cheng, L. (2013). Routine exposure of recurrent laryngeal nerve in thyroid surgery can prevent nerve injury. Neural regeneration research, 8(17), 1568–1575. https://doi.org/10.3969/j.issn.1673-5374.2013.17.00
29. Steward, D.L. (2014). The pros and cons of outpatient thyroidectomy. JAMA Otolaryngol Head Neck Surg, 140:1074–6. doi: 10.1001/jamaoto.2014.2353. 30. Wang, Y., Bhandari, A., Yang, F., Zhang, W., Xue, L., Liu, H., Zhang, X., Chen, C. (2017). Risk factors for hypocalcemia and hypoparathyroidism following thyroidectomy: a retrospective Chinese population study. Cancer Manag Res, 9:627-635https://doi.org/10.2147/CMAR.S148090
European Scientific Journal, ESJ ISSN: 1857-7881 (Print) e - ISSN 1857-7431
February 2023 edition Vol.19, No.6
www.eujournal.org 89
Dissections in Papillary Thyroid Carcinoma: A Modified Procedure to Reduce Parathyroid Morbidity. In vivo (Athens, Greece), 30(3), 303–308. 4. Balentine, C.J., Sippel, R.S.(2016). Outpatient Thyroidectomy: Is it Safe?.Surg Oncol Clin N Am, 25(1):61-75. doi: 10.1016/j.soc.2015.08.003 5. Canu, G.L., Medas, F., Cappellacci, F., Giordano, A.B.F., Gurrado, A., Gambardella, C., Docimo, G., et al. (2022). Risk of Complications in Patients Undergoing Completion Thyroidectomy after Hemithyroidectomy for Thyroid Nodule with Indeterminate Cytology: An Italian Multicentre Retrospective Study. Cancers (Basel), 17;14(10):2472. doi: 10.3390/cancers14102472. 6. Caulley, L., Johnson-Obaseki, S., Luo, L., & Javidnia, H. (2017). Risk factors for postoperative complications in total thyroidectomy: A retrospective, risk-adjusted analysis from the National Surgical Quality Improvement Program. Medicine, 96(5), e5752. https://doi.org/10.1097/MD.0000000000005752 7. Chen, Z., Zhao, Q., Du, J., Wang, Y., Han, R., Xu, C., Chen, X., & Shu, M. (2021). Risk factors for postoperative hypocalcaemia after thyroidectomy: A systematic review and meta-analysis. The Journal of international medical research, 49(3), 300060521996911. https://doi.org/10.1177/0300060521996911 8. Christou, N., Mathonnet, M. (2013). Complications after total thyroidectomy. J Visc Surg, 150(4):249-56. doi: 10.1016/j.jviscsurg.2013.04.003. 9. Christou, N., Mathonnet, M. (2013). Complications after total thyroidectomy. J Visc Surg,150(4):249-56. doi: 10.1016/j.jviscsurg.2013.04.003.
10. Dehal, A., Abbas, A., Al-Tememi, M., Hussain, F., Johna, S. (2014). Impact of surgeon volume on incidence of neck hematoma after thyroid and parathyroid surgery: ten years’ analysis of nationwide in-patient sample database. Am Surg, 80(10):948–952. https://doi.org/10.1177/000313481408001008 11. Del Rio, P., Carcoforo, P., Medas, F., Bonati, E., Loderer, T., Koleva Radica, M., & Calò, P. (2021). Adverse events in thyroid surgery: observational study in three surgical units with high volume/year. BMC surgery, 21(1), 352. https://doi.org/10.1186/s12893-021-01353-6 12. Del Rio, P., Rossini, M., Montana, C.M. et al. (2019). Postoperative hypocalcemia: analysis of factors influencing early hypocalcemia development following thyroid surgery. BMC Surg 18 (Suppl 1), 25 https://doi.org/10.1186/s12893-019-0483-y
European Scientific Journal, ESJ ISSN: 1857-7881 (Print) e - ISSN 1857-7431
February 2023 edition Vol.19, No.6
www.eujournal.org 90
13. Grogan, R.H., Mitmaker, E.J., Hwang, J., Gosnell, J.E., Duh, Q.Y., Clark, O.H., Shen, W.T. (2012). A population-based prospective cohort study of complications after thyroidectomy in the elderly. J Clin Endocrinol Metab, 97(5):1645–1653. doi: 10.1210/jc.2011-1162. 14. Hauch, A., Al-Qurayshi, Z., Randolph, G. et al. Total Thyroidectomy is Associated with Increased Risk of Complications for Low- and High-Volume Surgeons. Ann Surg Oncol 21, 3844–3852 (2014). https://doi.org/10.1245/s10434-014-3846-8 15. Haugen, B. R., Alexander, E. K., Bible, K. C., Doherty, G. M., Mandel, S. J., Nikiforov, Y. E., et al. (2016). 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid: official journal of the American Thyroid Association, 26(1), 1–133. https://doi.org/10.1089/thy.2015.0020
16. Hurtado-López, L.M., Zaldivar-Ramirez, F.R., Basurto, Kuba. E., et al. (2022). Causes for early reintervention after thyroidectomy. Med Sci Monit, 8: CR247–50. PMID: 11951065.
17. Lacoste, L., Gineste, D., Karayan, J., et al. (1993). Airway complications in thyroid surgery. Ann Otol Rhinol Laryngol, 102:441–6. DOI: 10.1177/000348949310200607. 18. Lukinović, J., & Bilić, M. (2020). Overview of Thyroid Surgery Complications. Acta clinica Croatica, 59(Suppl 1), 81–86. https://doi.org/10.20471/acc.2020.59.s1.10
19. Narayanan, S., Arumugam, D., Mennona, S., Wang, M., Davidov, T., Trooskin, S.Z. (2016). An evaluation of postoperative complications and cost after short-stay thyroid operations. Ann Surg Oncol, 23(5): 1440–1445. doi: 10.1245/s10434-015-5004-3.
20. Ortega, Beltrá. N., Martínez, Ruiz. de Apodaca. P., Guallart Doménech, F., Cuesta, González. M.T., Dalmau, Galofre. (2022). Postoperative hypocalcaemia predictors after total thyroidectomy. J. Rev Osteoporos Metab Miner, 14(4):131-135. DOI: http://dx.doi.org/10.4321/S1889-836X2022000300006en.
21. Pandey, A.K., Maithani, T., Agrahari, A., Varma, A., Bansal, C.H., Bhardwaj, A., et al. (2015). Postoperative Complications of Thyroid Surgery: A Corroborative Study with an Overview of Evolution of Thyroid Surgery. International Journal of Head and Neck Surgery, 6(4):149-154. DOI:105005/jp-journals-10001-1245.
22. Papaleontiou, M., Hughes, D.T., Guo, C., Banerjee, M., Haymart, M.R. (2017). Population-Based Assessment of Complications
European Scientific Journal, ESJ ISSN: 1857-7881 (Print) e - ISSN 1857-7431
February 2023 edition Vol.19, No.6
www.eujournal.org 91
Following Surgery for Thyroid Cancer. J Clin Endocrinol Metab, 102(7):2543–2551. DOI: 10.1210/jc.2017-00255. 23. Prgomet, Drago and Bilić, Mario and Kovač, Lana and Hutinec, Zdenka and Topić, Iva (2012) Lokalno invazivni papilarni karcinom štitnjače - naša iskustva [Locally invasive papillary thyroid cancer - our experience]. Liječnički vjesnik, 134 (9-10). pp. 266-20. ISSN 0024-3477.
24. S⊘rensen, K.R., Klug, T.E. (2015).Routine outpatient thyroid surgery cannot be recommended. Dan Med J, 62: pii: A5016. 25. Sadowski, S. M., Vidal Fortuny, J., & Triponez, F. (2017). A reappraisal of vascular anatomy of the parathyroid gland based on fluorescence techniques. Gland surgery, 6(Suppl 1), S30–S37. https://doi.org/10.21037/gs.2017.07.10
26. Sahmkow, S.I., Audet, N., Nadeau, S., et al. (2012). Outpatient thyroidectomy: safety and patients’ satisfaction. J Otolaryngol Head Neck Surg, (suppl 1): S1–2. PMID: 22569044.
27. Schwartz, A.E., Clark, O.H., Ituarte, P., Lo, Gerfo. P. (1998). Therapeutic controversy: Thyroid surgery the choice. J Clin Endocrinol Metab, 83:1097–105. doi: 10.1210/jcem.83.4.4740-1. 28. Shen, C., Xiang, M., Wu, H., Ma, Y., Chen, L., & Cheng, L. (2013). Routine exposure of recurrent laryngeal nerve in thyroid surgery can prevent nerve injury. Neural regeneration research, 8(17), 1568–1575. https://doi.org/10.3969/j.issn.1673-5374.2013.17.00
29. Steward, D.L. (2014). The pros and cons of outpatient thyroidectomy. JAMA Otolaryngol Head Neck Surg, 140:1074–6. doi: 10.1001/jamaoto.2014.2353. 30. Wang, Y., Bhandari, A., Yang, F., Zhang, W., Xue, L., Liu, H., Zhang, X., Chen, C. (2017). Risk factors for hypocalcemia and hypoparathyroidism following thyroidectomy: a retrospective Chinese population study. Cancer Manag Res, 9:627-635https://doi.org/10.2147/CMAR.S148090
Published
2023-02-28
How to Cite
Kokalari, I., Shundi, L., Abazaj, E., Ali, E., & Nikolla, L. (2023). Risk of Complications in Patients Undergoing Complete Thyroidectomy. A Retrospective Study. European Scientific Journal, ESJ, 19(6), 81. https://doi.org/10.19044/esj.2023.v19n6p81
Section
ESJ Natural/Life/Medical Sciences
Copyright (c) 2023 Igli Kokalari, Lila Shundi, Erjona Abazaj, Ela Ali, Ledina Nikolla
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