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To assess whether perioperative surgical outcomes associated with thyroid operations were different in those with benign or malignant conditions, we queried the NSQIP, a multi-institutional, risk-adjusted, prospective U.S. database.
A total of 10,838 patients who underwent initial thyroid surgery as their principal operation during 2005-2007 were a...
Context in source publication
Context 1
... total of 1.6% of patients in the whole cohort experi- enced a postoperative medical complication that did not reach significance between the two groups ( Table 3). There was no difference in the rates of wound infection or any other individual postoperative complication between benign and malignant disease except for the number of cerebrovascular accidents (CVA; P = .03), ...
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Background:
New surgical technologies have been introduced in thyroid surgery, to achieve vessel sealing and hemostasis. The aim of the study was to examine their effectiveness and compare the outcome of total thyroidectomy using the Harmonic Focus™, the LigaSure® Precise and the conventional technique of suture ligation.
Methods:
A retrospectiv...
Background:
The purpose of this study was to compare the surgical outcomes of robotic thyroidectomy (RT) using bilateral axillo-breast approach (BABA) with conventional open thyroidectomy (OT) in papillary thyroid carcinoma patients.
Methods:
Between January 2009 and December 2013, 815 patients who had received thyroidectomy for papillary thyroi...
The main barriers to short stay thyroidectomy are haemorrhage, bilateral recurrent laryngeal nerve palsy causing respiratory compromise and hypocalcaemia. This study assessed the safety and effectiveness of thyroidectomy as a 23-hour stay procedure.
All patients undergoing total or completion thyroidectomy were prescribed calcium and vitamin D3 sup...
Citations
... Several factors have been reported in the literature to be associated with early complications following thyroid surgery [43] [44] [45]. It has been reported in several studies that thyroid surgery performed for malignant neoplastic lesion of the thyroid is associated with increased risk of postoperative complications [45]. ...
... Several factors have been reported in the literature to be associated with early complications following thyroid surgery [43] [44] [45]. It has been reported in several studies that thyroid surgery performed for malignant neoplastic lesion of the thyroid is associated with increased risk of postoperative complications [45]. ...
... In this study as well as other studies [42] [45], thyroid surgery performed for malignant neoplastic lesion was found to be is associated with increased risk of postoperative complications. Malignant pathology is associated with increased vascularity, immunosuppression, and poor wound healing predisposing this to increased risk of postoperative complications [45]. ...
... The literature shows strong evidence that the incidence of perioperative complications correlates to factors such as thyroid disease, specific characteristics of each patient or the thyroid gland, surgeon's experience, and surgical technique, even with the use of optical magnification tools. [Duclos, A. et al., 2012-Goldfarb, M. et al., 2011 Wound infection, hematoma/haemorrhage causing airway impairment, hypocalcaemia, recurrent and superior laryngeal nerve damage, and thyroid storm are the most common postoperative consequences of thyroid surgery. Precise awareness of the precise anatomic features, as well as rigorous surgical technique, are required criteria for effective results and keeping problems to a minimum. ...
Introduction: Thyroidectomy is one of among the most often performed surgical operations globally. Over 34,000 surgeries were conducted in Italy throughout the year, with a total of 100,000 performed per year, as the frequency of thyroid illnesses requiring complete thyroidectomy continues to rise. Objective: This paper aims to the analysis of Thyroidectomy Results and Identification of Postoperative Complications for Iraqi Patients. Patients and methods: Our paper was presented as a cross-sectional study where it was developed to the analysis of Thyroidectomy Results and Identification of Postoperative Complications for Iraqi Patients who have ages in range 30-75 years. This data was included 46 cases that cover all sexes, males, and females, in different hospitals in Iraq from 25 th July 2021 to 19 th June 2022. The data collected was analysed and designed by the SPSS program. Discussion: After analysing the data, they discovered that greater thyroid gland vascularization is more closely associated to hyperthyroidism and that the existence of thyroiditis impacts the occurrence of parenchymal fibrosis. Conclusions: Total thyroidectomy is an essentially safe treatment, even though it exposed fewer parathyroid glands as well as recurrent laryngeal nerves and more surgical risk compared to unilateral thyroid lobectomy. Neither infection nor airway issues appear to impact the risk of postoperative patients, with only hypocalcaemia (transient) having a significant effect on postoperative patients.
... Using a large national database may seem to be a solution for studying such a rare outcome; however, these databases collect generalized surgical variables and outcomes and they do not contain thyroid specific variables. [17][18][19][20] To address this limitation, in January 2013, a thyroidectomy-specific module was added to the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) which became widely used after. 17 This database represents a randomized sample of patients who underwent thyroid operations in most hospitals in the United States and Canada. ...
Objective:
Examine the association of Graves' disease with the development of postoperative neck hematoma.
Design:
A cohort of patients participating in the Thyroid Procedure-Targeted Database of the National Surgical Quality Improvement Program from January 1, 2016 to December 31, 2018.
Setting:
A North American surgical cohort study.
Methods:
17 906 patients who underwent thyroidectomy were included. Propensity score matching was performed to adjust for differences in baseline covariates. Multivariate logistic regression was used to ascertain the association between thyroidectomy for Graves' disease and risk of postoperative adverse events within 30 days of surgery. The primary outcome was postoperative hematoma. Secondary outcomes were postoperative hypocalcemia and recurrent laryngeal nerve injury.
Results:
One-to-three propensity score matching yielded 1207 patients with mean age (SD) of 42.6 (14.9) years and 1017 (84.3%) female in the group with Graves' disease and 3621 patients with mean age (SD) of 46.7 (15.0%) years and 2998 (82.8%) female in the group with indications other than Graves' disease for thyroidectomy. The cumulative 30-day incidence of postoperative hematoma was 3.1% (38/1207) in the Graves' disease group and 1.9% (70/3621) in other patients. The matched cohort showed that Graves' disease was associated with higher odds of postoperative hematoma (OR 1.65, 95% CI 1.10-2.46) and hypocalcemia (OR 2.04, 95% CI 1.66-2.50) compared with other indications for thyroid surgery. There was no difference in recurrent laryngeal nerve injury among the 2 groups.
Conclusions:
Patients with Graves' disease undergoing thyroidectomy are more likely to suffer from postoperative hematoma and hypocalcemia compared to patients undergoing surgery for other indications.
... Patients undergoing thyroidectomy are exposed to the standard risks of any surgery, including bleeding and infection, but also the specific risks of recurrent laryngeal nerve (RLN) injury and symptomatic hypocalcemia. 1,2 These complications are relatively well studied among cohorts that include thyroidectomies performed for all indications. [1][2][3] Factors identified that influence rates of these complications include lower surgeon volume and the presence of thyroiditis. ...
... 1,2 These complications are relatively well studied among cohorts that include thyroidectomies performed for all indications. [1][2][3] Factors identified that influence rates of these complications include lower surgeon volume and the presence of thyroiditis. 3,4 Factors associated with complications in patients who undergo thyroidectomy for malignancy are not as well studied. ...
... There is some evidence that malignancy may be associated with higher rates of postoperative complications, but this has not been conclusively proven. 1,2,5 Theorized reasons for this include the desmoplastic reaction induced by the tumor and more extensive and aggressive surgery in the setting of cancerous or indeterminate fine-needle aspiration biopsy results. 5,6 In an effort to reduce the risk of RLN injury, intraoperative nerve monitoring (IONM) was developed. ...
Background
Recurrent laryngeal nerve (RLN) injury and postoperative hypocalcemia are potential complications of thyroidectomy, particularly in malignancy. Intraoperative nerve monitoring (IONM) remains controversial. We sought to evaluate the impact of IONM on these complications using a national data set.
Methods
The American College of Surgeons National Surgical Quality Improvement Program thyroidectomy-targeted data set was queried for patients who underwent thyroidectomies from 2016 to 2017. Patients were grouped according to IONM use. Logistic regression models were constructed to evaluate associations of variables with 30-day hypocalcemic events (HCEs) and RLN injury. Associations were expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs). A subgroup analysis was performed of patients with malignancy.
Results
A total of 9527 patients were identified; 5969 (62.7%) underwent thyroidectomy with IONM and 3558 (37.3%) without. By multivariable analysis, IONM had protective associations with HCE (OR = .81, 95% CI = .68-.96; P = .013) and RLN injury (OR = .83, 95% CI = .69-.98; P = .033). Malignancy increased risk of HCE (OR = 1.21, 95% CI=1.01-1.45; P = .038) and RLN injury (OR = 1.22, 95% CI = 1.02-1.46; P = .034). A large proportion (5943/9527, 62.4%) of patients had malignancy; 3646 (61.3%) underwent thyroidectomy with IONM and 2297 (38.7%) without. In the subgroup analysis, IONM had stronger protective associations with HCE (OR = .73, 95% CI = .60-.90; P = .003) and RLN injury (OR = .76, 95% CI = .62-.94; P = .012).
Discussion
Malignancy was associated with increased risk of HCE and RLN injury. Intraoperative nerve monitoring had a protective association with HCE and RLN injury, both overall, and in the malignant subgroup. Intraoperative nerve monitoring was correlated with improved thyroidectomy outcomes, especially if the indication was malignancy. This warrants further study to clarify cause and effect.
... Given that postoperative hematoma is rare, many single-institutional trials have been underpowered to demonstrate a difference. Observational studies 3,[14][15][16] in surgical research using large national generic databases contain generalized surgical variables and outcomes that have limitations in evaluating thyroid surgery outcomes. The Thyroid Procedure-Targeted Database from the National Surgical Quality Improvement Program (NSQIP) was developed and released in 2017 to address this limitation, collecting thyroid surgery-specific variables in granular detail across the United States and Canada. ...
Importance
Vessel-sealant devices (VSDs) have been popularized for use in thyroid operations; however, the association of their use with postoperative neck hematoma, a rare but potentially fatal complication, has not been well studied.
Objective
To examine the association of VSDs vs conventional hemostasis (CH) in thyroid operations with the development of neck hematoma.
Design, Setting, and Participants
This retrospective cohort study evaluated 10 903 patients in the Thyroid Procedure–Targeted Database of the National Surgical Quality Improvement Program from January 1, 2016, to December 31, 2017. One-to-one nearest-neighbor propensity score matching was conducted to adjust for differences in baseline covariates, including demographics, comorbidities, indications for thyroid procedure (goiter, Graves disease, malignant and benign thyroid nodule), and several other thyroid-specific characteristics, between the VSD and CH groups.
Main Outcomes and Measures
The primary outcome was postoperative hematoma requiring intervention with open evacuation, return to the operating room, tracheostomy, additional observation, or extended length of stay. Secondary outcomes include recurrent laryngeal nerve injury, operative duration, and hospital length of stay.
Results
One-to-one propensity score matching yielded 6522 patients (mean [SD] age, 52 [15] years; 8544 [78.4%] female) with 3261 in each exposure group such that distribution of observed baseline covariates was not different between groups of the same propensity score. Within the matched cohort, CH was associated with higher odds of neck hematoma compared with VSD (odds ratio, 2.33; 95% CI, 1.55-3.49; P < .001), with 34 (1.0%) hematomas in the VSD group and 78 (2.4%) in the CH group. On the basis of this analysis, the number needed to treat with a VSD to prevent 1 postoperative hematoma was 74. Secondary outcomes included longer length of hospital stay (incidence rate ratio, 1.29; 95% CI, 1.23-1.36; P < .001]) in the CH group compared with the VSD group but no difference in the odds of recurrent laryngeal nerve injury (odds ratio, 0.90; 95% CI, 0.73-1.11; P = .32) or operative duration (incidence rate ratio, 0.99; 95% CI, 0.96-1.01; P = .24).
Conclusions and Relevance
Use of VSDs during thyroid operations was associated with reduced odds of neck hematoma compared with CH techniques without increasing odds of nerve injury. The results suggest that postoperative neck hematoma rates after thyroid surgery may differ based on the hemostasis technique and that these differences should be considered when developing strategies for quality improvement of postoperative outcomes.
... First, reviewing the process of diagnosis and treatment, dyspnea occurred within 2 weeks rather than 48 h of surgery, no tracheomalacia was found intraoperatively, and postopera-tive CT did not reveal laryngeal edema; therefore, laryngeal edema and tracheal collapse can be excluded as the causes of dyspnea (3). No apparent hoarseness was observed in the patient, therefore excluding the possibility of bilateral recurrent laryngeal nerve injury. ...
The aim of the present study was to report a rare case of dyspnea caused by rapid growth of intratracheal lymphoma in the 2 weeks following thyroid surgery. A 53-year-old male patient underwent a right thyroidectomy due to tracheal compression by a mass of the right thyroid lobe. However, 2 weeks after the surgery, the patient developed dyspnea, which was managed by tracheotomy. An urgent computed tomography scan revealed that the soft tissue of the upper trachea was significantly thickened compared with prior to surgery, resulting in narrowing of the airway. Postoperative pathology revealed right thyroid lymphoma, and the final diagnosis was intratracheal lymphoma. The intratracheal mass regressed after chemotherapy combined with rituximab. We herein review the diagnostic and treatment process of this case of dyspnea, and analyze the outcome, in order to provide a reference for the timely diagnosis and treatment of patients developing dyspnea following thyroid surgery.
... [4][5][6] Although thyroid surgery in general has been deemed a fairly safe and straightforward operation in experienced hands, there are well-documented postoperative risks. 7 However, those risk and their associated factors have been described in the adult population, while pediatric thyroidectomies pose a unique set of technical challenges, 8 as well as relatively higher rates of respiratory and infectious complications. 9 Consequently, although most of the main principles in the treatment of pediatric cases are similar to those of adults, there are certain specific and distinctive characteristics in the diagnosis and surgical treatment of children with thyroid anomalies. ...
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
This article has been retracted at the request of the authors because of an error involving the dataset which doubled the reported sample size, thereby invalidating the analysis. The authors reported this error immediately upon discovering the problem. The authors regret the error.
... Risk assessment in surgery is essential to guide patientcentered treatment decisions but is variable in practice (6,7). Presently, risk assessment of perioperative complications is based on accepted or previously reported values and influenced by subjective provider assessment of individual patient comorbidities (8,9). ...
Background:
Improving surgical outcomes is important to patients, providers, and healthcare systems. Understanding best methods to ensure evidence based practices are successfully implemented and sustained in clinical practices leads to improved care. Dissemination and implementation (D&I) science facilitates the successful pathway from clinical trials to sustained implementation.
Methods:
We describe D&I science, introduce the consolidated framework for implementation research (CFIR), a D&I framework, and provide an example of how CFIR was utilized to facilitate the translational process from design adaptations to implementation, broad utilization by clinicians, and sustainability of the SUrgical Risk Preoperative Assessment System (SURPAS) tool into regular clinical practice. SURPAS creates data-driven individualized risk assessments of common adverse postoperative outcomes to enhance the informed consent process, shared decision making, and consequently improved surgical outcomes. The CFIR provided a structured systematic way to identify constructs influencing the D&I of SURPAS, including adaptations for the process and tool.
Results:
We identified three domains, each with specific constructs, that participants believed would strongly influence effectiveness of SURPAS implementation efforts: the importance of patients' perspectives (outer setting); the quality of SURPAS (intervention characteristic); and integration of SURPAS into the electronic health record (inner setting). Additionally, providers' positive attitudes toward and support of SURPAS (characteristics of individuals); and the ease of integration of SURPAS into the workflow (process), were also identified. Tension emerged between patients' preference of the provision of risk information and providers' concern about additional clinic time required for formal risk discussion with low-risk patients.
Conclusions:
Systematically identifying constructs from the beginning of the design through the implementation process can guide design of a multi-component strategy for future large-scale implementation by assessing the relative impact of factors on implementation using the CFIR framework. In the example studied, this allows key stakeholders to ensure success of D&I of SURPAS at multiple levels and times, continuously optimizing the process.
... In the study conducted by Antonio Rios-Zambudio et al., 69 patients who underwent thyroidectomy hd hyperthyroidism; hypocalcemia developed in 28 (45%) of these; and it was determined in statistical analyses that it was at a significant level (7). (18)(19)(20)(21). In our study, postoperative complications in malign thyroid diseases compared to the patients operated due to benign pathology was higher; however, this was not significant. ...
Aim: The purpose of this study was to determine the postoperative complications in total thyroidectomy patients based on the weight of the thyroid gland with retrospective screening.Material and Methods: A total of 263 adult patients, who underwent total thyroidectomy were included. The data automation system of the hospital and the files of the patients were examined retrospectively.Results: The total complication incidence was 24.3%, and these were determined as hypocalcemia, vocal cord paralyses (VCP), and hemorrhage and seroma at the surgery area. The rate of temporary hypocalcemia and permanent hypocalcemia rate was 20.1% and 1.5% respectively. The temporary VCP rate was 0.3% (n=1), and no permanent VCP was observed in the patients. The median thyroid weight was measured as 50 gr in patients without postoperative hypocalcemia, and as 40 g in the patients with hypocalcemia (p=0.283). There was no significant relation between the variability in the weight of the thyroid and postoperative hypocalcemia. However, the cervical lymph node dissection (LND) (p=0.006) and cervical dissection site (p=0.031) were significant in terms of postoperative complication development. In the multivariate analyses, it was found that female gender and LND were independent risk factors in the development of postoperative complications.Conclusion: It was determined that cervical LND and female gender were independent risk factors. Consistent with the literature findings, no significant results were found in the risk factors like heavy thyroid gland, presence of thyroid operation history, malignant thyroid pathology, retrosternal localization of the thyroid tissue, and hyperthyroidism.
... However, contrasting with our study, none of the existing studies on general postoperative complications focused on patients with thyroid cancer or additionally addressed thyroid surgeryspecific complications. Previously reported overall rates of thyroid surgeryspecific postoperative complications varied significantly, ranging between 0.4% and 7.4% in single-institution studies (16,27,28). One study from Brazil reported an overall thyroid surgery-specific complication rate as high as 18.0%, but only 25% of the patients included had thyroid cancer (17). ...
Context:
As thyroid cancer incidence rises, more patients undergo thyroid surgery. Although post-operative complication rates have been reported in single institution studies, population-based data is limited.
Objective:
Determine thyroid cancer surgery complication rates and identify at-risk populations.
Design/setting/patients:
Using the Surveillance, Epidemiology, and End Results-Medicare database, we evaluated general complications within 30 days and thyroid surgery specific complications within one year in 27,912 patients who underwent surgery for differentiated or medullary thyroid cancer between 1998-2011. Multivariable analyses of patient characteristics associated with post-operative complications were performed.
Main outcome measures:
General and thyroid surgery specific complications.
Results:
Overall, 1820 (6.5%) patients developed general post-operative complications (fever, infection, hematoma, cardiopulmonary, thromboembolic events) and 3427 (12.3%) developed thyroid surgery specific complications (hypoparathyroidism/hypocalcemia, vocal cord/fold paralysis). In multivariable analyses, general and thyroid surgery specific complication rates were significantly higher in patients >65 years (OR 2.61, 95% CI 2.31-2.95; OR 3.12, 95% CI 2.85-3.42), those with a Charlson/Deyo comorbidity score of 1 (OR 2.40, 95% CI 1.66-3.49; OR 1.88, 95% CI 1.53-2.31) and ≥2 (OR 7.05, 95% CI 5.33-9.56; OR 3.62, 95% CI 3.11-4.25), and those with regional (OR 1.18, 95% CI 1.03-1.35; OR 1.31, 95% CI 1.19-1.45) or distant disease (OR 2.83, 95% CI 2.30-3.47; OR 1.85, 95% CI 1.54-2.21), respectively.
Conclusions:
The rates of thyroid cancer surgery complications are higher than predicted, and patients with older age, more comorbidities and advanced disease are at greatest risk. This has implications for patients undergoing thyroid cancer surgery. Efforts to reduce complications are needed.
