Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients.
ABSTRACT During recent years, more radical surgery for thyroid disease, i.e., total instead of subtotal resection, has been evident. Results following this strategy on national levels are scarce.
From 2004 to 2006, 26 Scandinavian Departments registered 3,660 thyroid operations in a database. Risk factors for complications were analyzed with multiple logistic regression.
After thyroidectomy, re-bleeding occurred in 2.1% and was associated with older age (OR 1.04; p < 0.0001) and male gender (OR 1.90; p = 0.014). Postoperative infection occurred in 1.6% and associated with lymph node operation (OR 8.18; p < 0.0001). Postoperative unilateral paresis of the recurrent laryngeal nerve was diagnosed 3.9% and bilateral paresis in 0.2%. Unilateral paresis was associated with older age, intrathoracic goiter, thyreotoxicosis, and if routine laryngoscopy was practiced (OR 1.92; p = 0.0002). After 6 months, the incidence of nerve paresis was 0.97%. After bilateral thyroid surgery (n = 1,648), hypocalcaemia treated with vitamin D analogue occurred in 9.9% of the patients at the first follow-up and in 4.4% after 6 months.
Complications to thyroid surgery are not uncommon. The high frequency of hypocalcaemia treated with vitamin D after 6 months is a cause of concern.
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ABSTRACT: Various energy based surgical devices (ESD) like electrotome have been widely applied in thyroid surgery. This is the first canine model to determine the safety margin of using the electrotome near the recurrent laryngeal nerve (RLN) to prevent injury to this nerve during thyroid surgery. Eighteen healthy male dogs were divided equally into three groups according to the distance between electrotome application and the RLN: Group A (5 mm), Group B (3 mm), Group C (1 mm). The parameters of evoked electromyography (EEMG) of vocal muscles between right normal RLNs and left RLNs after electrotome application at a power of 30 W for 1 second in each group were recorded and compared. The acute microstructural morphological changes of the RLNs were observed immediately after the operation under electron microscope. In Group B and Group C, after using the electrotome at a vertical distance of 3 mm or 1 mm from the left RLNs, the stimulating thresholds of left RLNs had a significant increase (P = 0.005; P = 0.002) compared with right normal RLNs, and there occurred obvious acute microstructural morphological changes under electron microscope for left RLNs. While there was no significant functional or histological changes for left RLNs after using the electrotome at a vertical distance of 5 mm from the RLN (P = 0.187) in Group A. When using the electrotome near the RLN at a power of 30W in thyroid surgery, a safety margin of more than 3 mm should be recommended.International Journal of Clinical and Experimental Medicine 01/2015; 8(1):770-5. · 1.42 Impact Factor
Article: Vía clínica de tiroidectomía[Show abstract] [Hide abstract]
ABSTRACT: Clinical pathways are care plans applicable to patient care procedures that present variations in practice and a predictable clinical course. They are designed not as a substitute for clinical judgment, but rather as a means to improve the effectiveness and efficiency of the procedures. This clinical pathway is the result of a collaborative work of the Sections of Endocrine Surgery and Quality Management of the Spanish Association of Surgeons. It attempts to provide a framework for standardizing the performance of thyroidectomy, the most frequently performed operation in endocrine surgery. Along with the usual documents of clinical pathways (temporary matrix, variance tracking and information sheets, assessment indicators and a satisfaction questionnaire) it includes a review of the scientific evidence around different aspects of pre, intra and postoperative management. Among others, antibiotic and antithrombotic prophylaxis, preoperative preparation in hyperthyroidism, intraoperative neuromonitoring and systems for obtaining hemostasis are included, along with management of postoperative hypocalcemia.Cirugía Española 02/2015; 93(5). DOI:10.1016/j.ciresp.2014.11.010 · 0.89 Impact Factor
Otolaryngology Head and Neck Surgery 06/2013; 148(6 Suppl):S1-S37. DOI:10.1177/0194599813487301 · 1.72 Impact Factor