R Daher1, J-C Lifante2, N Voirin3, J-L Peix1, C Colin4, J-L Kraimps5, F Menegaux6, F Pattou7, F Sebag8, S Touzet4, S Bourdy4, A Duclos9. 1. Hospices civils de Lyon, Centre hospitalier Lyon-Sud, Service de chirurgie générale et endocrinienne, Pierre-Bénite, F-69495, France. 2. Hospices civils de Lyon, Centre hospitalier Lyon-Sud, Service de chirurgie générale et endocrinienne, Pierre-Bénite, F-69495, France. Electronic address: jean-christophe.lifante@chu-lyon.fr. 3. Hospices civils de Lyon, Hôpital Édouard-Herriot, Service d'hygiène, épidémiologie et prévention, Lyon, F-6943, France; Université de Lyon 1, Laboratoire de biométrie et biologie évolutive, Lyon, F-69373, France; CNRS, UMR 5558, Laboratoire de biométrie et biologie évolutive, Lyon, F-69373, France. 4. Hospices civils de Lyon, Pôle information médicale évaluation recherche, Lyon, F-69003; Université de Lyon, EA Santé-Individu-Société 4129, Lyon, F-69002, France. 5. Department of Endocrine Surgery, Poitiers University, Jean-Bernard Hospital, 86021-Poitiers, France. 6. Assistance publique-Hôpitaux de Paris, Hôpital la Pitié-Salpêtrière, Service de chirurgie générale, viscérale et endocrinienne, Paris, France. 7. CHRU de Lille, Chirurgie générale et endocrinienne, Lille, 59000, France; Université Lille-Nord de France, INSERM, UMR 859, Lille, 59000, France. 8. Assistance publique-Hôpitaux de Marseille, CHU la Timone-Adulte, France. 9. Hospices civils de Lyon, Pôle information médicale évaluation recherche, Lyon, F-69003; Center for Surgery and Public Health, Brigham and Women's Hospital - Harvard Medical School, Boston, MA, USA; Université de Lyon, EA Santé-Individu-Société 4129, Lyon, F-69002, France.
Abstract
OBJECTIVE: Inferior laryngeal nerve (ILN) palsy and hypocalcemia remain the two most frequent major complications after thyroid surgery. Their occurrences may be explained by the influence of factors related to the patient, the surgical procedure, thyroid pathology, or the surgeon's technique. This study aims To assess whether systematically following a rigorous surgical technique during thyroidectomy affects postoperative complications and long-term patient recovery. METHODS: We conducted a multicenter, cross-sectional study of prospectively collected data in five high-volume referral centers enrolling all patients who underwent thyroid surgery between April 2008 and December 2009. Inferior laryngeal nerve (ILN) palsy and hypocalcemia were systematically assessed during hospitalization based on objective criteria. A six-month follow-up was conducted in cases of early complications. Multivariate regression models were computed to quantify their relationship with potential risk factors. RESULTS: A total of 3574 thyroid procedures were completed. Non-visualization of the ILN during dissection and a large thyroid mass were major risk factors for permanent ILN palsy (OR, 4.17 and 2.61, p<0.01) and persistent complications after initial injury (OR, 4.17 and 2.42, p<0.05). The presence of thyroiditis on the surgical specimen was an independent risk factor for permanent hypoparathyroidism and poor recovery after initial dysfunction (OR, 1.76 and 1.88, p<0.05). CONCLUSIONS: Thorough meticulous technique in thyroid surgery is a determinant of ILN function but fails to prevent persistent hypoparathyroidism.
OBJECTIVE: Inferior laryngeal nerve (ILN) palsy and hypocalcemia remain the two most frequent major complications after thyroid surgery. Their occurrences may be explained by the influence of factors related to the patient, the surgical procedure, thyroid pathology, or the surgeon's technique. This study aims To assess whether systematically following a rigorous surgical technique during thyroidectomy affects postoperative complications and long-term patient recovery. METHODS: We conducted a multicenter, cross-sectional study of prospectively collected data in five high-volume referral centers enrolling all patients who underwent thyroid surgery between April 2008 and December 2009. Inferior laryngeal nerve (ILN) palsy and hypocalcemia were systematically assessed during hospitalization based on objective criteria. A six-month follow-up was conducted in cases of early complications. Multivariate regression models were computed to quantify their relationship with potential risk factors. RESULTS: A total of 3574 thyroid procedures were completed. Non-visualization of the ILN during dissection and a large thyroid mass were major risk factors for permanent ILN palsy (OR, 4.17 and 2.61, p<0.01) and persistent complications after initial injury (OR, 4.17 and 2.42, p<0.05). The presence of thyroiditis on the surgical specimen was an independent risk factor for permanent hypoparathyroidism and poor recovery after initial dysfunction (OR, 1.76 and 1.88, p<0.05). CONCLUSIONS: Thorough meticulous technique in thyroid surgery is a determinant of ILN function but fails to prevent persistent hypoparathyroidism.
Authors: C Raspanti; C Porrello; G Augello; A Dafnomili; G Rotolo; A Randazzo; N Falco; T Fontana; R Tutino; G Gulotta Journal: G Chir Date: 2017 Jan-Feb
Authors: G Baud; L Brunaud; J C Lifante; C Tresallet; F Sebag; J P Bizard; M Mathonnet; F Menegaux; R Caiazzo; É Mirallié; F Pattou Journal: J Chir Visc Date: 2020-04-30