Body Mass Index (BMI) Related Morbidity with Thyroid Surgery

Abstract

ObjectivesThe increase in incidence of thyroid cancer correlates with strict increases in body mass index (BMI) and obesity in the United States. Thyroid hormone dysregulation has been shown to precipitate circulatory volume, peripheral resistance, cardiac rhythm, and even cardiac muscle health. Theoretically, thyroid surgery could precipitate injury to the cardiopulmonary system.MethodsThe American College of Surgery National Quality Improvement Program database was queried for thyroidectomy cases in the 2007–2020 Participant User files. Continuous and categorical associations between BMI and cardiopulmonary complications were investigated as reported in the database.ResultsThe query resulted 186,095 cases of thyroidectomy procedures in which the mean age was 51.3 years and sample was 79.3% female. No correlation was evident in univariate and multivariate analyses between BMI and the incidence of postoperative stroke or myocardial infarction. The incidence of complications was extremely low. However, risk of deep venous thrombosis correlated with BMI in the categorical, univariate, and multivariate (OR 1.036, CI 1.014–1.057, p < 0.01) regression analysis. Additionally, increased BMI was associated with increased risk of pulmonary embolism (PE) (OR 1.050 (1.030, 1.069), p < 0.01), re‐intubation (OR 1.012 (1.002, 1.023), p = 0.02), and prolonged intubation (OR 1.031 (1.017, 1.045), p < 0.01).ConclusionDespite the rarity of cardiopulmonary complications during thyroid surgery, patients with very high BMI carry a significant risk of deep venous thrombosis, PE, and prolonged intubation.Level of Evidence3 Laryngoscope, 133:2823–2830, 2023

Preoperative Serum Albumin as Predictor of Outcomes After Thyroidectomy

“…Previous studies have also suggested malnutrition, as measured by serum albumin, as a predictor of poor surgical outcomes in neurosurgical, plastic and reconstructive, cardiac, and gastrointestinal surgeries 6‐9 . Several studies have also investigated the effect of body mass index, but there are mixed findings on its significance as a predictor of adverse postoperative outcomes 10,11 . Albumin is considered a negative active‐phase protein that typically decreases during injury and inflammatory conditions and has been shown to be an independent risk factor for mortality in the elderly 12 .…”

“… 6 , 7 , 8 , 9 Several studies have also investigated the effect of body mass index, but there are mixed findings on its significance as a predictor of adverse postoperative outcomes. 10 , 11 Albumin is considered a negative active‐phase protein that typically decreases during injury and inflammatory conditions and has been shown to be an independent risk factor for mortality in the elderly. 12 However, little is known about the significance of early preoperative hypoalbuminemia as a predictor of postoperative outcomes following thyroidectomy.…”