Clinical Science
Can a surgeon predict the risk of postoperative hypoparathyroidism during thyroid surgery? A prospective study on self-assessment by experts

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Abstract

Background

Thyroid surgery can cause postoperative hypocalcemia (POH) and permanent hypoparathyroidism (PEH). Surgeons implicitly assess the risk and adapt their surgical strategy accordingly.

Methods

The outcome of this intraoperative decision-making process (the surgeons' ability to predict the risk of POH and PEH on a numerical rating scale and their actual incidence) was studied prospectively in 2,558 consecutive thyroid operations.

Results

POH and PEH occurred in 723 and 64 patients, respectively. In multivariate analysis, the surgeons' risk assessment score was an independent predictive factor for both complications (P < .05). Surgeons' differed significantly (P = .015) in their rates of POH but not of PEH (P = .062). Six and 3 (of 9) surgeons correctly predicted an increased risk of PEH and POH (adjusted odds ratios 1.67 to 2.21 and 1.47 to 12.73), respectively.

Conclusion

The risk for hypoparathyroidism can be estimated, but surgeons differ substantially in this ability and in the extent to which this implicit knowledge is translated into lower complication rates.

Section snippets

Study design and patient population

In a prospective study, 2,558 patients who underwent thyroid surgery at the Department of Surgery, Kaiserin Elisabeth Hospital, Vienna, Austria, from February 2009 to January 2012 and who were willing to participate were included. Moreover, surgeons had to agree to the study; not all surgeons were willing to participate. Patients who suffered from concomitant hyperparathyroidism, preoperative hypocalcemia, or preoperative hypoparathyroidism were excluded.

Immediately after the operation,

Patient population

Of a total of 2,558 thyroid operations (1,988 women, 77.7%; 570 men, 22.3%), POH and PEH occurred in 723 (28.3%) and 64 (2.5%) patients, respectively. Patients had a median age of 55 years (range 16 to 88). Details on final diagnosis after thyroid surgery are provided in Table 1.

Multivariate analyses for the prediction of postoperative hypocalcemia and permanent hypoparathyroidism

In multivariate models, we included several possible risk factors to predict POH and PEH. For both, POH and PEH, the surgeons' risk assessment score was a significant predictive factor (Table 2). In addition, other risk

Comments

This prospective study on more than 2,500 thyroid operations provided the following key findings: (1) even experienced surgeons in a center with more than 1,300 thyroidectomies per year differed in rates of parathyroid complications after thyroid surgery; (2) an individual risk assessment scored by the surgeons directly after the operation provided useful predictive information; (3) POH was more reliably predicted than the less frequent complication of PEH and (4) individual surgeons also

References (17)

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