Skip to main content

Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients

Abstract

Background and Aim

During recent years, more radical surgery for thyroid disease, i.e., total instead of subtotal resection, has been evident. Results following this strategy on national levels are scarce.

Materials and methods

From 2004 to 2006, 26 Scandinavian Departments registered 3,660 thyroid operations in a database. Risk factors for complications were analyzed with multiple logistic regression.

Results

After thyroidectomy, re-bleeding occurred in 2.1% and was associated with older age (OR 1.04; p < 0.0001) and male gender (OR 1.90; p = 0.014). Postoperative infection occurred in 1.6% and associated with lymph node operation (OR 8.18; p < 0.0001). Postoperative unilateral paresis of the recurrent laryngeal nerve was diagnosed 3.9% and bilateral paresis in 0.2%. Unilateral paresis was associated with older age, intrathoracic goiter, thyreotoxicosis, and if routine laryngoscopy was practiced (OR 1.92; p = 0.0002). After 6 months, the incidence of nerve paresis was 0.97%. After bilateral thyroid surgery (n = 1,648), hypocalcaemia treated with vitamin D analogue occurred in 9.9% of the patients at the first follow-up and in 4.4% after 6 months.

Conclusion

Complications to thyroid surgery are not uncommon. The high frequency of hypocalcaemia treated with vitamin D after 6 months is a cause of concern.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Delbridge L (2003) Total thyroidectomy: the evolution of surgical technique. ANZ J Surg 73:761–768 doi:10.1046/j.1445-2197.2003.02756.x

    PubMed  Article  Google Scholar 

  2. 2.

    Barakate MS, Agarwal G, Reeve TS, Barraclough B, Robinson B, Delbridge LW (2002) Total thyroidectomy is now the preferred option for the surgical management of Graves’ disease. ANZ J Surg 72:321–324 doi:10.1046/j.1445-2197.2002.02400.x

    PubMed  Article  Google Scholar 

  3. 3.

    Acun Z, Comert M, Cihan A, Ulukent SC, Ucan B, Cakmak GK (2004) Near-total thyroidectomy could be the best treatment for thyroid disease in endemic regions. Arch Surg 139:444–447 discussion 447 doi:10.1001/archsurg.139.4.444

    PubMed  Article  Google Scholar 

  4. 4.

    Thomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H (2003) The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery 133:180–185 doi:10.1067/msy.2003.61

    PubMed  Article  Google Scholar 

  5. 5.

    Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I et al (2000) Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 24:1335–1341 doi:10.1007/s002680010221

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG et al (2004) Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 28:271–276 doi:10.1007/s00268-003-6903-1

    PubMed  Article  Google Scholar 

  7. 7.

    Dixon AJ, Dixon MP, Dixon JB (2007) Bleeding complications in skin cancer surgery are associated with warfarin but not aspirin therapy. Br J Surg 94:1356–1360 doi:10.1002/bjs.5864

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E et al (2004) Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 136:1310–1322 doi:10.1016/j.surg.2004.07.018

    PubMed  Article  Google Scholar 

  9. 9.

    Horne SK, Gal TJ, Brennan JA (2007) Prevalence and patterns of intraoperative nerve monitoring for thyroidectomy. Otolaryngol Head Neck Surg 136:952–956 doi:10.1016/j.otohns.2007.02.011

    PubMed  Article  Google Scholar 

  10. 10.

    Randolph GW, Kobler JB, Wilkins J (2004) Recurrent laryngeal nerve identification and assessment during thyroid surgery: laryngeal palpation. World J Surg 28:755–760 doi:10.1007/s00268-004-7348-x

    PubMed  Article  Google Scholar 

  11. 11.

    Shindo M, Chheda NN (2007) Incidence of vocal cord paralysis with and without recurrent laryngeal nerve monitoring during thyroidectomy. Arch Otolaryngol Head Neck Surg 133:481–485 doi:10.1001/archotol.133.5.481

    PubMed  Article  Google Scholar 

  12. 12.

    Loch-Wilkinson TJ, Stalberg PL, Sidhu SB, Sywak MS, Wilkinson JF, Delbridge LW (2007) Nerve stimulation in thyroid surgery: is it really useful? NZ J Surg 77:377–380 doi:10.1111/j.1445-2197.2007.04065.x

    Article  Google Scholar 

  13. 13.

    Snyder SK, Lairmore TC, Hendricks JC, Roberts JW (2008) Elucidating mechanisms of recurrent laryngeal nerve injury during thyroidectomy and parathyroidectomy. J Am Coll Surg 206:123–130 doi:10.1016/j.jamcollsurg.2007.07.017

    PubMed  Article  Google Scholar 

  14. 14.

    Jarhult J, Rudberg C, Larsson E, Selvander H, Sjovall K, Winsa B et al (2005) Graves’ disease with moderate-severe endocrine ophthalmopathy—long term results of a prospective, randomized study of total or subtotal thyroid resection. Thyroid 15:1157–1164 doi:10.1089/thy.2005.15.1157

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Witte J, Goretzki PE, Dotzenrath C, Simon D, Felis P, Neubauer M et al (2000) Surgery for Graves’ disease: total versus subtotal thyroidectomy-results of a prospective randomized trial. World J Surg 24:1303–1311 doi:10.1007/s002680010216

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Thomusch O, Sekulla C, Ukkat J, Gastinger L, Lippert H, Dralle H (2001) Quality assurance study of benign and malignant goiter. Prospective multicenter data collection regarding 7,617 patients. Zentralbl Chir 126:664–671 doi:10.1055/s-2001-18249

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Agada FO, King-Im JU, Atkin SL, England RJ (2005) Does thyroid subspecialization alter practice and outcome? A completed 4-year audit loop. Clin Otolaryngol 30:48–51 doi:10.1111/j.1365-2273.2004.00909.x

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R (1998) The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 228:320–330 doi:10.1097/00000658-199809000-00005

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Stavrakis AI, Ituarte PH, Ko CY, Yeh MW (2007) Surgeon volume as a predictor of outcomes in inpatient and outpatient endocrine surgery. Surgery 142:887–899 discussion 887–899 doi:10.1016/j.surg.2007.09.003

    PubMed  Article  Google Scholar 

  20. 20.

    Pieracci FM, Fahey TJ 3rd (2008) Effect of hospital volume of thyroidectomies on outcomes following substernal thyroidectomy. World J Surg 32:740–746

    PubMed  Article  Google Scholar 

Download references

Acknowledgment

The study was supported by grants from the European Union (Interreg. III A), the Swedish National Board for Health and Welfare and the Swedish Association of Local Authorities and Regions.

Author information

Affiliations

Authors

Corresponding author

Correspondence to A. Bergenfelz.

Additional information

S. Jansson, A. Kristoffersson, H. Mårtensson, E. Reihnér, G. Wallin and I Lausen are all members of the Steering Committee for the Scandanavian Quality Register for Throid and Parathyroid Surgery.

Best of Endocrine Surgery in Europe 2008.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bergenfelz, A., Jansson, S., Kristoffersson, A. et al. Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg 393, 667–673 (2008). https://doi.org/10.1007/s00423-008-0366-7

Download citation

Keywords

  • Thyroid
  • Surgery
  • Complications
  • Audit
  • Database