Scientific Papers
Morbidity of thyroid surgery

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Abstract

Background: Morbidity is today’s concern in thyroid surgery. The purpose of this paper was to quantify risk factors’ contribution to morbidity rates.

Methods: During 50 months, 1,163 patients undergoing 1,192 thyroidectomies at one hospital were reviewed at follow-up of 8 to 58 months.

Results: There was 1 death (0.08%). Wound morbidity included 19 hematomas (1.6%), 3 chyle leaks (0.2%), and 6 abscesses (0.5%). Mean hospital stay was 4.3 days after surgery without drain and 5.3 days with drain (P <0.01). Temporary and permanent hypoparathyroidism (TH; PH) rates were 20% and 4%. Parathyroid autografting and excision rates were 19% and 9%. TH rates were higher after parathyroid autografting or accidental excision (P <0.01). There was no correlation between the severity of TH and the number of lymph nodes at neck dissection nor between postoperative serum calcium levels and the number of parathyroids identified at bilateral surgery. Temporary and permanent recurrent laryngeal nerve (RLN) palsy (TRLNP; PRLNP) rates were 2.9% and 0.5% (0.3% of 2,010 RLNs at risk). PH and TRLNP (not PRLNP) rates were higher after completion or total thyroidectomy with node dissection (P <0.01). TRLNP and PRLNP rates after RLN exposure and after nonexposure were not statistically different. Surgical volume had no bearing on hematoma, abscess, TH, PH, TRLNP, and PRLNP rates.

Conclusions: High surgical volume, identifying parathyroids and RLNs, failed to reduce morbidity. Completion and total thyroidectomy with node dissection increased PH and TRLNP (not PRLNP) rates.

Section snippets

Material and methods

From March 1989 to May 1993, 1,163 consecutive patients underwent 1,192 thyroidectomies (Table I). There were 1,021 women and 142 men with a mean age of 46.9 years (range 14.5 to 88.1). Patients with associated hyperparathyroidism were excluded from the study. All patients had their history taken and physical examination, routine chemistry determinations, thyroid function tests, and chest radiographs. The preoperative work-up consisted of thyroid ultrasound, scan, fine needle aspiration (FNA)

Results

There was one death (0.08%). Wound morbidity included 12 superficial and 7 deep hematomas (1.59%), 3 chyle leaks (0.25%), and 6 abscesses (0.5%). Ten hemorrhages (3 superficial and 7 deep) were reexplored a median of 240 minutes (range 15 minutes to 15 days) after surgery (median time was 30 hours and 60 minutes for superficial and deep hematomas, respectively) with no further complications. Nine patients with small superficial hemorrhage showing no progression recovered without reoperation. No

Comments

Our data, in accordance with those of Shaha and Jaffe,6 are not in support of increased morbidity rates in thyroid surgery performed by surgeons with low patient volume provided that surgeons with high volume are supervising. In our series, surgical volume had no bearing on hematoma, abscess, temporary and permanent RLN palsy, and temporary and permanent hypoparathyroidism rates. Postoperative hematoma accounted for 0.08% mortality rate in our series with a 1.5% hematoma rate, which is similar

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