What is the prevalence of complications of thyroid surgery?

Updated: Jan 25, 2018
  • Author: Pramod K Sharma, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Meltzer et al developed a model to predict the risk of 30-day complications from thyroid surgery, with the presence of thyroid cancer being the most significant variable. Among patients with thyroid cancer, the presence of coronary artery disease and the use of central neck dissection also predict increased risk, according to the model, while in patients without thyroid cancer, complications are predicted by coronary artery disease, dyspnea, complete thyroidectomy, and lobe size. [2]

A retrospective study by Caulley et al found that out of 40,025 total thyroidectomies, inpatient and outpatient, the 30-day complication rate was 7.74%. The study determined that for inpatient procedures, complication rates were affected by such preoperative factors as age 70 years or older, non-Caucasian race, dependent functional status, a history of congestive heart failure, a history of smoking, a bleeding disorder, wound infection, and preoperative sepsis. For outpatient procedures, complication rates were also affected by malignant thyroid pathology. [3]

A study by Al-Qurayshi et al indicated that economic and social factors influence the outcomes of thyroidectomies in the United States. The study, which involved data from 14,220 inpatient and 7215 outpatient thyroidectomies, found that persons from high–health-risk communities undergoing thyroidectomy were more likely to be women and African Americans and that they had a higher likelihood of being operated on by low-volume surgeons. They also had a greater risk of suffering postoperative complications and of being readmitted to the hospital and also tended to have longer hospital stays. [4]

Nonetheless, a retrospective study by Ayala and Yencha indicated that hospitals with a low surgical volume can safely perform outpatient thyroid surgery. The study, involving 160 patients who underwent either total thyroidectomy (61 patients) or hemithyroidectomy (99 patients) at a low-surgical volume facility, found that the hospital discharged 109 patients on the day of surgery, while 43 patients were admitted to the hospital for 23-hour observation and eight patients were admitted for longer than 24 hours. Among the surgical complications encountered were temporary recurrent laryngeal nerve (RLN) injury (four patients), permanent RLN injury (one patient), temporary bilateral RLN injury (one patient), delayed hematoma (two patients), and transient hypocalcemia (eight patients). [5]

By understanding the presentation and treatment of each complication, the surgeon can handle complications expediently and avoid worsening consequences. In general, complications of thyroid surgery can be divided into minor, rare, or major.


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