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Mortality after thyroid surgery, insignificant or still an issue?

Abstract

Background

Thyroidectomy is considered to be a safe procedure. Although very uncommon, death may occur after thyroid resection. The aim of this study was to investigate the prevalence and causes of death after thyroidectomy and the associated risk factors in the modern era of thyroid surgery.

Patients and Methods

A structured questionnaire was sent to all endocrine surgery units in Spain to report all deaths that occurred after thyroidectomy in recent years.

Results

Twenty-six surgical units, encompassing 30.495 thyroidectomies, returned the questionnaire. A total of 20 deaths (0.065 %) were recorded: 12 women (60 %) and 8 men (40 %) with a median age of 65 years (range 32–86). Half of the patients had a retrosternal goiter with a median weight of 210 g. The median operative time was 185 min. Histological diagnoses were benign goiter (35 %) or thyroid carcinoma (65 %): differentiated (30 %), medullary (20 %), poorly differentiated/anaplastic (10 %), and colorectal cancer metastasis (5 %). Causes of death were cervical hematoma (30 %), respiratory distress/pneumonia due to prolonged endotracheal intubation (25 %), tracheal injury (15 %), heart failure (15 %), sepsis (wound infection/esophageal perforation) (10 %) and mycotic aneurysm (5 %). The median time from surgery to death was 14 days (range 1–85).

Conclusions

Death after thyroidectomy is very uncommon, and most often results from a combination of advanced age, giant goiters, and upper airway complications.

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Acknowledgments

To all surgeon members of the Spanish Association of Surgeons that completed and returned the survey questionnaire: Cristina Santos (Hospital Costa del Sol, Marbella), Guzmán Franch Arcas (Hospital de Salamanca), Antonio Jiménez (Hospital Virgen de la Macarena, Sevilla), Ana Carrión (Hospital de Alicante), María Isabel Bollo Arocena (Hospital de Donostia), Xavier Guirao (Hospital General de Granollers), Joan de la Cruz Verdún (Hospital de Mataró), Aitor Quintana de la Basarrate (Hospital de Cruces, Bilbao), Joan Domenech Calvet (Hospital de Sant Joan, Reus), Adolfo Basañez Amuchastegui (Hospital de Galdácano), Susana Ros López (Hospital Arnau de Vilanova de Lleida), María Balsalobre (Hospital Santa Lucía de Cartagena), Mari Fe Candel Arenas (Hospital Reina Sofía de Murcia), Cristina Sabater (Hospital de Guadalajara), Nuria Muñoz (Hospital Virgen de las Nieves, Granada), Carmen González Sánchez (Hospital de Salamanca), and Cristina Álvarez Segurado (Hospital de Son Espases, Palma de Mallorca).

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Correspondence to Joaquín Gómez-Ramírez.

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Gómez-Ramírez, J., Sitges-Serra, A., Moreno-Llorente, P. et al. Mortality after thyroid surgery, insignificant or still an issue?. Langenbecks Arch Surg 400, 517–522 (2015). https://doi.org/10.1007/s00423-015-1303-1

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  • DOI: https://doi.org/10.1007/s00423-015-1303-1

Keywords

  • Thyroidectomy
  • Risk factors
  • Mortality
  • Causes