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Comparison of postoperative pain between transoral and conventional thyroidectomy: a propensity score-matched analysis

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Abstract

Background

The extent of postoperative pain following transoral thyroidectomy is not well-understood and remains a subject of debate. This study aims to analyze and compare postoperative pain levels between patients undergoing transoral and conventional transcervical thyroidectomy.

Methods

A prospective evaluation on postoperative pain was conducted in 310 patients undergoing conventional thyroidectomy and 194 undergoing transoral thyroidectomy. Pain levels were evaluated using the numerical rating scale (NRS, ranging from 0 to 10) through preoperative and postoperative questionnaires at specified time points: 1, 3, and 6 days, and 1 and 3 months following surgery. Propensity score-matched analysis was carried out based on six covariates: sex, age, body mass index, extent of thyroidectomy, tumor size, and central neck dissection.

Results

After propensity score matching based on the six covariates, 121 patient pairs were identified from each group. Within this matched cohort, postoperative pain scores significantly worsened 1 day after surgery but showed progressive recovery up to 3 months post-surgery in both groups. The transoral group exhibited higher postoperative pain scores than the conventional group from day 1 (4.43 ± 2.6 vs. 3.11 ± 2.5, p < 0.001) to day 6 (1.76 ± 1.9 vs. 1.13 ± 1.6, p = 0.016) post-surgery, with no significant difference noted at 1 month. Among transoral procedures, pain scores were significantly higher for the endoscopic approach compared to the robotic approach on days 1 (5.52 ± 2.3 vs. 4.29 ± 2.3, p = 0.028) and 3 (3.52 ± 2.5 vs. 2.64 ± 2.0, p = 0.047) post-surgery.

Conclusions

Postoperative pain was significantly higher in transoral thyroidectomy compared to conventional thyroidectomy up to 6 days post-surgery. Within the transoral group, the robotic procedure resulted in lower pain levels than the endoscopic approach during the early postoperative period.

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Data availability

Data supporting the findings of this study are available from the corresponding author upon reasonable request.

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Funding

The authors have not disclosed any funding.

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Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, 222 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, Republic of Korea

    Min Kyu Park, Van Cuong Nguyen, Chang Myeon Song, Yong Bae Ji, Jin Hyeok Jeong & Kyung Tae

  2. Department of Anesthesiology and Pain Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea

    Eugene Kim

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  1. Min Kyu Park
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  2. Van Cuong Nguyen
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  3. Eugene Kim
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  4. Chang Myeon Song
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  7. Kyung Tae
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Contributions

Study concept and design: KT, acquisition, analysis, or interpretation of data: All authors. drafting of the manuscript: MKP. Critical revision of the manuscript for important intellectual content: KT. Statistical analysis: VCN, MKP. Administrative, technical, or material support: KT. Study supervision: KT.

Corresponding author

Correspondence to Kyung Tae.

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Conflict of interest

Min Kyu Park, Van Cuong Nguyen, Eugene Kim, Chang Myeon Song, Yong Bae Ji, Jin Hyeok Jeong, and Kyung Tae have no conflicts of interest or financial ties to disclose.

Ethical approval

This study was approved by the institutional review board (IRB) of Hanyang University Hospital (IRB No: 2022–12-057).

Informed consent

Informed consent was obtained from all patients.

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Park, M.K., Nguyen, V.C., Kim, E. et al. Comparison of postoperative pain between transoral and conventional thyroidectomy: a propensity score-matched analysis. Surg Endosc 38, 1512–1522 (2024). https://doi.org/10.1007/s00464-023-10656-z

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  • DOI: https://doi.org/10.1007/s00464-023-10656-z

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