Mohemmed N Khan 1 , Erden Goljo 2 , Randall Owen 3 , Richard Chan Woo Park 4 , Mike Yao 2 , Brett A Miles 2 Show Affiliations »
Abstract
OBJECTIVE: Retrosternal goiters pose a significant challenge in determining the indications and appropriate approach for surgical removal while limiting postoperative morbidity and mortality. The objective of this study is to use the National Surgical Quality Improvement Program (NSQIP) database to compare outcomes of transcervical and transthoracic approaches for retrosternal goiter removal and to review the literature regarding the varying indications for the 2 surgical approaches. STUDY DESIGN: Administrative database analysis. SETTING: NSQIP database. SUBJECTS AND METHODS: The NSQIP database was queried for all cases of retrosternal thyroid: 2716 patients were included, which represents one of the largest data reviews of patients with retrosternal thyroid pathology who underwent surgery. Data were analyzed to examine morbidity and mortality of the cervical and transthoracic approaches. RESULTS: Patient demographics and preoperative comorbidities were similar between groups. Patients undergoing a transthoracic approach experienced increased rates of unplanned intubations and need for transfusion and length of stay postoperatively. CONCLUSIONS: A transthoracic approach is associated with increased rates of several critical postoperative morbidities, and the data indicate the potential of increased overall mortality. Given equivalent retrosternal extension, a transcervical approach should be attempted whenever anatomically possible, regardless of pathology. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.
OBJECTIVE: Retrosternal goiters pose a significant challenge in determining the indications and appropriate approach for surgical removal while limiting postoperative morbidity and mortality. The objective of this study is to use the National Surgical Quality Improvement Program (NSQIP) database to compare outcomes of transcervical and transthoracic approaches for retrosternal goiter removal and to review the literature regarding the varying indications for the 2 surgical approaches. STUDY DESIGN: Administrative database analysis. SETTING: NSQIP database. SUBJECTS AND METHODS: The NSQIP database was queried for all cases of retrosternal thyroid: 2716 patients were included, which represents one of the largest data reviews of patients with retrosternal thyroid pathology who underwent surgery. Data were analyzed to examine morbidity and mortality of the cervical and transthoracic approaches. RESULTS: Patient demographics and preoperative comorbidities were similar between groups. Patients undergoing a transthoracic approach experienced increased rates of unplanned intubations and need for transfusion and length of stay postoperatively. CONCLUSIONS: A transthoracic approach is associated with increased rates of several critical postoperative morbidities, and the data indicate the potential of increased overall mortality. Given equivalent retrosternal extension, a transcervical approach should be attempted whenever anatomically possible, regardless of pathology. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.
Entities: Disease
Species
Keywords:
substernal goiter; thyroid disease; thyroid neoplasm; thyroid nodule; thyroidectomy
Mesh： See more »
Year: 2016
PMID： 27221572 DOI： 10.1177/0194599816649583
Source DB: PubMed Journal: Otolaryngol Head Neck Surg ISSN： 0194-5998 Impact factor: 3.497