Elsevier

Surgery

Volume 133, Issue 2, February 2003, Pages 180-185
Surgery

Original Communications
The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: A multivariate analysis of 5846 consecutive patients*,**

https://doi.org/10.1067/msy.2003.61Get rights and content

Abstract

Background. Limited information exists about risk factors for postoperative hypoparathyroidism after bilateral thyroid surgery. Methods. Between January 1 and December 31, 1998, bilateral thyroid surgery was performed on 5846 patients for benign and malignant thyroid disease. Data were prospectively collected by questionnaires from 45 hospitals. A logistic regression model was used to determine independent risk factors. Results. The overall incidence of transient and permanent hypoparathyroidism was 7.3% and 1.5%, respectively. On logistic regression analysis, total thyroidectomy (odds ratio [OR], 4.7), female gender (OR, 1.9), Graves' disease (OR, 1.9), recurrent goiter (OR, 1.7), and bilateral central ligation of the inferior thyroid artery (OR, 1.7) constituted independent risk factors for transient hypoparathyroidism. When the multivariate analysis was confined to permanent hypoparathyroidism, total thyroidectomy (OR, 11.4), bilateral central (OR, 5.0) and peripheral (OR, 2.0) ligation of the inferior thyroid artery, identification and preservation of no or only a single parathyroid gland (OR, 4.1), and Graves' disease (OR, 2.4) emerged as independent risk factors. Conclusions. Extent of resection and surgical technique had a greater impact on the rates of permanent postoperative hypoparathyroidism than thyroid pathologic condition. In bilateral thyroid surgery, peripheral ligation of the inferior thyroid artery at the thyroid capsule should be favored over central ligation, and at least 2 parathyroid glands should be identified and preserved. High-risk procedures, such as total thyroidectomy and Graves' disease, require special surgical training and expertise. (Surgery 2003; 133:180-5.)

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.

. Postoperative transient and permanent hypoparathyroidism by surgical indication

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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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    *

    Reprint requests: Oliver Thomusch, MD, Department of General Surgery, Albert-Ludwigs University Freiburg, Hugstetter Str. 55, D-79106 Freiburg, Germany.

    **

    0039-6060/2003/$30.00 + 0

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