Impact of body mass index on post‐thyroidectomy morbidity

Blanchard, Claire; Bannani, Sahar; Pattou, François; Brunaud, Laurent; Hamy, A.; Christou, Niki; Mathonnet, Muriel; Dahan, M.; Prades, Jean-Michel; Landecy, G.; Dernis, Henri-Pierre; Sébag, F.; Babin, E.; Bizon, A.; Lifante, Jean-Christophe; Jégoux, F.; Volteau, Christelle; Caillard, C.; Riche, Valéry-Pierre; Mirallié, Éric

doi:10.1002/hed.25773

Cited by 16 publications

(17 citation statements)

References 17 publications

(48 reference statements)

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“…Most of the studies conducted so far on the correlation between elevated BMI and postoperative morbidity in the field of thyroid surgery confirm our findings [ 4 , 10 – 13 , 15 ]. Only three studies documented an increased occurrence of complications [ 5 , 16 , 17 ].…”

Section: Discussionsupporting

confidence: 90%

Can thyroidectomy be considered safe in obese patients? A retrospective cohort study

et al. 2020

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Background Obesity is a growing public health concern in most western countries. More and more patients with high body mass index (BMI) are undergoing surgical procedures of all kinds and, in this context, obese patients are undergoing thyroid surgery more than ever before. The aim of the present study was to evaluate whether thyroidectomy can be considered safe in obese patients. Methods Patients undergoing thyroidectomy in our Unit between January 2014 and December 2018 were retrospectively analysed. Patients were divided into two groups: those with BMI < 30 kg/m2 were included in Group A, while those with BMI ≥ 30 kg/m2 in Group B. Univariate analysis was performed to compare these two groups. Moreover, multivariate analyses were performed to evaluate whether the BMI value (considered in this case as a continuous variable) had a significant role in the development of each individual postoperative complication. Results A total of 813 patients were included in this study: 31 (3.81%) were underweight, 361 (44.40%) normal-weight, 286 (35.18%) overweight, 94 (11.57%) obese and 41 (5.04%) morbidly obese. Six hundred and seventy-eight patients were included in Group A and 135 in Group B. At univariate analysis, the comparison between the two groups, in terms of operative time and thyroid weight resulted in statistically significant results (P = 0.001, P = 0.008; respectively). These features were significantly higher in Group B than in Group A. About postoperative stay and complications, no statistically significant difference was found between the two groups. At multivariate analyses, only the development of cervical haematoma was statistically significantly correlated to the BMI value. Patients with high BMI had a lower risk of cervical haematoma (P = 0.045, OR 0.797, 95% CI 0.638–0.995). Conclusions This study showed that obesity, in the field of thyroid surgery, is not associated with any increase of postoperative complications. Thus, it is possible to conclude that thyroidectomy can be performed safely in obese patients. Our result about operative times had no clinical significance.

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Section: Discussionsupporting

confidence: 90%

Can thyroidectomy be considered safe in obese patients? A retrospective cohort study

et al. 2020

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“…Controversy remains whether obesity increases intra-and postoperative morbidity. A recent prospective analysis did not reveal higher complication rates, despite a longer duration of the procedure (30). This finding conflicts with previous studies advocating that bariatric surgery should be performed first (31,32).…”

Section: Discussionmentioning

confidence: 63%

Is there a relationship between different types of prior bariatric surgery and post-thyroidectomy hypocalcemia?

Calì¹,

Hasani²,

Buffet³

et al. 2021

Gland Surg

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Background: Hypocalcemia is a common complication after total thyroidectomy (TT). A history of bariatric surgery has been identified as a risk factor for this complication. This study aimed to assess the risk of hypocalcemia post TT in patients with a history of obesity procedures: laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and laparoscopic gastric banding (LAGB).Methods: We compared the risk of hypocalcemia post TT (serum calcium levels <8 mg/dL) between patients with restrictive (LSG and LAGB), malabsorptive (RYGB), and patients without a history of obesity surgery. Hypoparathyroidism was considered permanent if the plasma parathyroid hormone (PTH) levels at 6 months were less than 15 pg/mL (normal range: 15-65 pg/mL) and the patient still required oral calcium (calcium carbonate) and vitamin D supplementation, in addition to the supplements that were taken routinely before thyroidectomy.Results: From the 13,242 patients who underwent TT from 2006 to 2018, 90 patients (0.7%) had a history of bariatric surgery: 35 LAGB, 29 LSG, and 26 RYGB. The risk of hypocalcemia was higher in RYGB patients (50%, n=13) than in LAGB (17.1%, n=6) or LSG patients (20.6%, n=6) (P=0.003). Furthermore, hypocalcemia risk was similar between patients with a history of restrictive procedures (18.8%, 12/64) and patients with no history of bariatric surgery (17.2%, 2,268/13,152) (P=0.4). Permanent hypoparathyroidism was observed in one and 6 patients from the LAGB and RYGB groups, respectively; however, it was not observed in any patient from the LSG group.Conclusions: RYGB is a risk factor for hypocalcemia post TT, while restrictive bariatric procedures are not.

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“…Past/current smoker 11,913 (20) 673 (15) 3231 (17) 3870 (21) 3221 (23) 918 ( 25 19,747 (33) 1388 (32) 6010 (31) 6219 (34) 4820 (35) 1310 ( 35)…”

Section: Resultsmentioning

confidence: 99%

“…Consequently, we consider that both underweight and overweight patients with thyroid cancer can undergo surgery as safely as patients with normal BMI, and clinicians must pay attention to general complications in obese patients. Previous studies have demonstrated discordant results regarding the association between BMI and short-term outcomes following thyroid cancer surgery (18,19,20,21), presumably because these studies failed to adjust for certain patients' background characteristics (e.g. cancer stage, intraoperative device use and some comorbidities).…”

Section: Discussionmentioning

confidence: 99%

“…A US study involving 18,825 patients who underwent thyroidectomy reported that BMI > 25 kg/m 2 was significantly associated with higher morbidity and longer operative time, but the study did not include RLN paralysis as the outcome, and the results were not adjusted for cancer stage or most of the above-stated factors (18). Other studies in France and Italy showed no significant differences in post-operative complications among different BMI categories despite longer operative time in patients with BMI > 25 kg/m 2 than in those with normal BMI (19,20,21). However, because these studies had a relatively small number of cases, the analyses lacked adjustment for the patients' backgrounds.…”

Section: Introductionmentioning

confidence: 95%

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Impact of body mass index on short-term outcomes after differentiated thyroid cancer surgery: a nationwide inpatient database study in Japan

Konishi

Fujiogi

Michihata

et al. 2022

European Thyroid Journal

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Introduction Recent studies have shown worse post-operative outcomes following several surgeries in underweight or obese patients. However, the association between body mass index (BMI) and short-term outcomes following thyroid cancer surgery remains unclear because of the small number of patients, deficits in background data known as risk factors (e.g. cancer stage, operative procedure, intraoperative device use and hospital volume) and categorisation of BMI. Methods We identified patients who underwent thyroidectomy for differentiated thyroid cancer from July 2010 to March 2017 using a Japanese nationwide inpatient database. We used restricted cubic spline (RCS) analyses to investigate potential non-linear associations between BMI (without categorisation) and outcomes: post-operative complications (local and general), duration of anaesthesia, post-operative length of hospital stay and hospitalisation costs. The analyses were adjusted for demographic and clinical backgrounds including the above-stated factors. We also performed multivariable regression analyses for the outcomes with categorisation of BMI. Results Among 59,671 eligible patients, the median BMI was 22.9 kg/m2 (interquartile range (IQR), 20.7–25.6 kg/m2). In total, 3860 patients (6.5%) had local complications and 787 patients (1.3%) had general complications. Although there were no significant associations with local complications, such as bleeding, recurrent laryngeal nerve paralysis and surgical site infection, the occurrence of general complications was significantly associated with higher BMI. BMI showed a linear association with the duration of anaesthesia and U-shaped associations with post-operative length of stay and hospitalisation costs. The lowest points of the U-shaped curves occurred at a BMI of approximately 24 kg/m2. The multivariate regression analyses showed consistent results with the RCS analyses. Discussion/conclusion Whereas RCS analyses revealed no significant associations between BMI and post-operative local complications, obesity was significantly associated with the occurrence of general complications. The linear association between BMI and duration of anaesthesia corresponds to previous studies. Although post-operative length of stay and total hospitalisation costs demonstrated U-shaped associations, the slight differences would not be clinically important. Even if surgeons must pay attention to general complications in obese patients undergoing thyroid cancer surgery as well as other surgeries, underweight and overweight patients can undergo thyroidectomy as safely as patients with normal BMI.

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Impact of body mass index on post‐thyroidectomy morbidity

Cited by 16 publications

References 17 publications

Can thyroidectomy be considered safe in obese patients? A retrospective cohort study

Can thyroidectomy be considered safe in obese patients? A retrospective cohort study

Is there a relationship between different types of prior bariatric surgery and post-thyroidectomy hypocalcemia?

Impact of body mass index on short-term outcomes after differentiated thyroid cancer surgery: a nationwide inpatient database study in Japan

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