Original CommunicationsThe impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: A multivariate analysis of 5846 consecutive patients*,**
Section snippets
Study design
Between January 1 and December 31, 1998, all patients undergoing bilateral thyroid surgery for benign and malignant thyroid conditions in 45 participating German hospitals were enrolled, a total of 5861 patients. The multicenter study was conducted under the auspices of the German Society of Surgery. Data were collected prospectively by questionnaires on an anonymous basis to comply with national data protection and confidentiality regulations. The design of the study was observational, leaving
Patient demographics and indication for surgery
Among the 5846 consecutive patients enrolled, 5640 patients were operated on for benign, and 206 patients for malignant, thyroid conditions. The mean age was 52.7 years for patients with benign goiter, and 52.9 years for patients with thyroid carcinoma. In both benign and malignant thyroid conditions, female gender prevailed with 77.8% and 70.2%, respectively. Indications for thyroid surgery are listed in Table I.Empty Cell
Discussion
The primary end point of this investigation, postoperative hypoparathyroidism, is an infrequent phenomenon in thyroid surgery. The feasibility of simultaneously incorporating many risk factors into a single logistic regression model is heavily dependent on the number of events encountered, ie, on the rate of postoperative hypoparathyroidism. To accommodate for the rarity of this condition, a multicenter design involving 45 hospitals was used in this series, allowing us to recruit 5846 patients
Conclusions
This multivariate analysis disclosed that postoperative hypoparathyroidism is a multifactorial phenomenon. It is worthy to note that extent of resection and surgical technique had a greater impact on permanent postoperative hypoparathyroidism than thyroid pathologic condition. The current series suggests that, in bilateral thyroid surgery, peripheral ligation of the inferior artery close to the thyroid capsule should be favored over central ligation (ie, near the carotid artery) and that at
Acknowledgements
We gratefully acknowledge the logistic support of Henning Berlin GmbH & Co, Berlin, Germany. We are especially grateful to the many contributors to this multicenter study that was conducted under the auspices of the German Society of Surgery.
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Cited by (0)
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Reprint requests: Oliver Thomusch, MD, Department of General Surgery, Albert-Ludwigs University Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany.
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0039-6060/2003/$30.00 + 0