COMMENTARY

Comparing Cervical and Substernal Thyroidectomy

Albert B. Lowenfels, MD

Disclosures

September 24, 2007

Substernal Thyroidectomy is Associated with Increased Morbidity and Mortality as Compared with Conventional Cervical Thyroidectomy

Pieracci FM, Fahey TJ.
J Am Coll Surg. 2007;205:1-7

The authors used a large database of all New York State hospitalizations to compare the outcomes after cervical and substernal thyroidectomy during 1998-2004. Of the 33,930 total operations, 97% (32,777) were cervical procedures. Patients undergoing substernal operations were older, sicker, and less likely to have private insurance than patients with cervical operations. Furthermore, they were less likely to undergo surgery at high volume centers. Patients requiring substernal procedures also had an 8-fold increased risk of death, and a higher frequency of complications.

Using information from large administrative databases can be informative, especially for less frequently performed procedures such as substernal thyroidectomy; 1.4% of patients requiring a substernal approach died compared to 0.1% of deaths after a cervical operation. The respective cancer rates for substernal and cervical goiters were 23% and 30%. The older age of patients with substernal goiters and the relative lack of private insurance suggests that duration of thyroid disease before surgery might be longer in patients with substernal goiters.

Abstract

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