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Risk factors for difficult thyroidectomy and postoperative morbidity do not match: retrospective study from an endocrine surgery academic referral centre

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Abstract

Hyperthyroidism, goiter and thyroiditis have been associated with complex thyroidectomy. Difficult thyroidectomies may implicate longer operating times and higher complication rates, while literature on quantification and prediction of difficulty in thyroidectomy is scant. We aim at assessing the impact of preoperative and intraoperative factors on the technical difficulty of total thyroidectomy (TT) and on the incidence of postoperative complications. We conducted a retrospective study on 197 TT from 343 thyroidectomies performed with intraoperative neuromonitoring between October 2019 and June 2022 (excluding lobectomies, nodal dissection, extra-thyroidal procedures). Operating time (surrogate of TT difficulty), postoperative hypocalcaemia, recurrent laryngeal nerve palsy and postoperative bleeding were assessed in relation to pre- and intraoperative characteristics. Vocal fold palsy(VFP) was defined as recovering < 12 months postoperatively. There were 87 thyroid cancers and 110 multinodular goiters (21 hyperfunctioning, 51 mediastinal). Median operating time was 136 min (range 51–310). Within 17.4 months overall median follow-up we recorded two transient VFPs and 12% symptomatic transient hypocalcaemia. At univariable analysis male sex (p = 0.005), BMI (p < 0.001), thyroiditis (p < 0.05), hypervascular goiter (p = 0.003) and thyroid adhesions to surrounding anatomical structures (p < 0.001) were associated with longer operating time. At multivariable analysis male male sex (p = 0.01), obesity (p = 0.001) and thyroid adhesions (p = 0.008) were factors for prolonged operating time. Above-normal anti-thyroid peroxidase antibodies correlated to transient symptomatic hypocalcemia (p < 0.001). Risk factors for complex TT were identified and did not correlate with morbidity rates. Results from this study may help optimizing operating room schedule and inform case selection criteria for training programs in thyroid surgery. Further research is required to confirm these findings.

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Availability of data and material

Original population and Patients’ data supporting this study are available upon request from the Department of Biomedical Sciences and Human Oncology—Academic Unit General Surgery.

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Acknowledgements

FPP Concept and design of the study; data and literature review, draft writing, manuscript review. PCP Manuscript review, intellectual input. GDM Acquisition and review of data, intellectual input. AP Data review, critical review, intellectual input. LIS Data review, draft writing, intellectual input. GC Data analysis, intellectual input. RD Data analysis, intellectual input. FF Data review, manuscript review, intellectual input. MT Literature review, draft writing, critical review, intellectual input. AG Coordination of the study, manuscript review, intellectual input. All the authors read and approved the final manuscript.

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Authors and Affiliations

  1. Academic General Surgery Unit, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro” Medical School, 11, Piazza Giulio Cesare, 70124, Bari, Italy

    F. P. Prete, P. C. Panzera, G. Di Meo, A. Pasculli, L. I. Sgaramella, G. Calculli, R. Dimonte, F. Ferrarese, M. Testini & A. Gurrado

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  1. F. P. Prete
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Correspondence to F. P. Prete.

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This research has been conducted in compliance with Ethical Standards of Research involving human participants, in accordance with the declaration of Helsinki. The study was approved by the Institutional Review Board of the University Medical School of Bari.

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Patient consent for research use of data was obtained for each case presented. All identification data of the patients were removed from medical records prior to data collection. De-identified data were used, and it was not possible to trace any of the data to the actual individual. Only information required for coherent description of cases was extracted. Data in electronic format were accessible to authorized personnel only.

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Prete, F.P., Panzera, P.C., Di Meo, G. et al. Risk factors for difficult thyroidectomy and postoperative morbidity do not match: retrospective study from an endocrine surgery academic referral centre. Updates Surg 74, 1943–1951 (2022). https://doi.org/10.1007/s13304-022-01371-w

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