Early complications of thyroid surgery: Analysis of 2100 patients

Abstract

Background/Aims. Thyroid gland surgery today is not saddled with high incidence of main complications. Miscellaneous surgical institutions with different surgical approach, operative technique and radicality have published reports with great discrepancy in incidence of complications, analyzing them with different methods of diagnosis and result evaluation. In the same way it is well known that higher latitude of operative procedure gave better control of thyroid diseases, but it can be accompanied with more complications. All of that motivate us to analyze complications of operative treatment in our patients under well known criteria, with hypothesis that higher radicality of operative procedure do not increase incidence of complications, and that this incidence is in correlations with results published in world literature. Aim of this nonrandomized study was to analyze results of operative treatment for huge number of consecutively operated patients in our teaching hospital, to analyze and compare results according to group of diseases and operative procedures, and to compare final results with results published in the world literature. Methods. Complications of operative treatment were analyzed retrospectively for period 1988-1997 (Group I) and prospectively in period 1998-2002 (Group II). Operations were performed by 20 surgeons and 20 young surgeons during their education. We have analyzed only complications during first 30 days after operation. Results. In Group I there was 1425 patients with 1451 operations (192 thyroid malignances, 247 hyperthireosis, 98 reoperations, 13% thyreoidectomies and 14,8% lobectomies), with complication rate of 14,3%. Most common complication was recurrent laryngeal nerve injury in 9,3% patients or 6,3% according to number of exposed nerves („nerve at risk“), then postoperative hypocalcemia with rate of 4,7% (persistent in 1,3%). In Group II in 675 patients there was 687 operations (96 thyroid malignances, 111 hyperthireosis, 35 reoperations, 36,6% thyreoidectomies and 25% lobectomies), with complication rate of 10,7%. Most common postoperative complication was hypocalcemia with 5% rate (persistent in 0,7%), then recurrent laryngeal nerve injury in 4,4% patients or 2,9% according to number of exposed nerves („nerve at risk“). Incidence of recurrent laryngeal nerve injury in Group II is less frequent than in Group I, highly statistically significant (p<0,01), while for other complications there is no statistically significant difference. Totally for both groups there was 0,7% tracheotomies, postoperative bleeding in 1,1% of patients, wound haemathoma in 0,5%, wound infections in 0,9%, pneumonia in 0,5%, mortality 0,5% and most common cause of death (8/11) was problem with respiration, „Airway obstruction“. In Group II complications were less frequent in total thyreoidectomies in relation to lobectomy with contra lateral subtotal lobectomy. In both groups and totally incidence of complications was higher in reoperations, in patients with more extensive operative procedure, in ma...

Risk factors for postoperative bleeding after thyroid surgery

“…It is therefore not surprising that postoperative bleeding is a complication of thyroid surgery. The findings of the present investigation are consistent with published results from other large studies1, 14–18. The present analysis showed variability in individual surgeon performance, although they all had experience of at least 300 thyroid operations.…”

“…Postoperative bleeding is an important complication after thyroidectomy and may be the limiting factor for outpatient thyroid surgery or early discharge from hospital1–4. Numerous articles have reported on postoperative bleeding after thyroid operations, with an incidence ranging from 0 to 6·5 per cent1, 3, 5–21. A review of publications containing large cohorts of more than 1000 patients from single centres found rates of 0·3–1·2 per cent.…”

Experience of thyroid surgery at a tertiary care hospital in Karachi, Pakistan

“…Thyroid surgery is relatively safest surgery and the mortality rates has been fallen in recent years from 40% in 1800s to 0-0.05% in recent years, owing to better preoperative preparations and improved surgical techniques resulting in minimum complications [18][19][20]. Our data shows differs in these fi gures as we found 3 deaths and mortality rate of 0.14% in 2094 patients due to our large sample size.…”

Total Versus Subtotal Thyroidectomy for Benign Multinodular Goiter: Outcome and Complications

“…Mortality rate from thyroid surgery during the 1800s was approximately 40%. Most deaths were caused by infection and hemorrhage but nowadays the incidence of death ranges from zero to 0.5% [8,14,15]. Thyroid surgery in recent years is generally considered quite safe owing to better preoperative preparation and proper surgical techniques that kept complications at a minimum to less than 2-3% [16].…”

“…Our study showed that postoperative hemorrhage and hematoma formation were seen in three patients (2.5%) in ST group while four patients (3.3%) in T group with insignificance statistical difference that came in concordance with many reports. The rate of postoperative hemorrhage varied from 0.56% to 1.1% in many series [9,14,16,[24][25][26] while others described their experiences of thyroidectomies with hemorrhage up to 2.5% [27].…”