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Comparison of different thyroid surgical procedures and their outcomes/complications for benign disease in relation to expertise of the surgeon in a public hospital of a developing country over 2 decades

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Nov 13, 2020 version files 50.69 KB

Abstract

Objective: To compare the frequency of postoperative complications with thyroid surgical procedures and the expertise of the surgeon.

Design: Retrospective cross-sectional study from 1999 to 2018.

Setting: A public sector tertiary care teaching hospital.

Participants and methods: Patients undergoing thyroid surgery (lobectomy with isthmusectomy, subtotal thyroidectomy (STT), near total thyroidectomy (NTT), or total thyroidectomy (TT)) were included. Expertise level 1, 2 and 3 (L1, L2, L3) of the surgeon was based on years of experience or number of thyroid surgeries to their credit.

Primary and Secondary Outcome Measures: Postoperative complications (hypocalcemia, recurrent laryngeal nerve (RLN) damage, airway obstruction, hemorrhage and mortality) were measured against type of thyroid surgery and expertise of surgeon.

Results: 833 thyroid surgeries were performed on 695 (83.43%) females and 138 (16.57%) males. 502 (60.26%) STT, 228 (27.37%) TT, 61 (7.32%) NTT, 42 (5.04%) lobectomies with isthmusectomies were performed, with LI, 2, and 3 surgeons performing 21.25%, 45.74% and 33.01%, respectively. L1, 2 and 3 surgeons caused 49.47%, 33.45% and 17.08% of adverse events respectively. The permanent hypocalcemia, RLN damage and mortality were significantly (p<0.05) more common in surgeries performed by L1 compared with L2 and L3.  Transient and permanent hypocalcemia, transient and permanent RLN damage and mortality were significantly (p<0.01) more common for total thyroidectomy compared to subtotal thyroidectomy.

Conclusion: Minimizing the occurrence of complications like permanent hypocalcemia, RLN damage and mortality, expertise of the surgeon and anticipated difficulty of the procedure needs to be taken into account while selecting a thyroid procedure.

Keywords: Thyroid surgery, Total thyroidectomy, Subtotal thyroidectomy, near total thyroidectomy, Lobectomy with isthmusectomy, hypoparathyroidism, hypocalcemia, recurrent laryngeal nerve, postoperative complications