Pediatric Thyroidectomy: NSQIP-P Analysis of Adverse Perioperative Outcomes

Patel, Vijay A.; Khaku, Aliasgher; Carr, Michele M.

doi:10.1177/0003489419889069

Cited by 16 publications

(25 citation statements)

References 30 publications

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“…This suggests such complications could be related to the difficulty of the dissection itself, and also with the loss of thyroid architecture, which means similar results would be achieved by any surgeon. In terms of perioperative aspects, mean operating time (162.3 minutes) was similar to that described in series with over 700 patients (160.9) (10) , and no differences were found regarding hospital stay and analgesic control vs. other authors.…”

Section: Discussionsupporting

confidence: 69%

Pediatric thyroidectomy in a "low volume" institution without protocolization: results and future horizons

Moreno-Alfonso¹,

Caballero²,

Martínez³

et al. 2022

Cir Pediatr

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Objective. Pediatric thyroidectomy is an infrequent, complex surgery, with high risk of complications. Complication rates and oncological results of non-protocolized thyroidectomy in a secondary pediatric hospital were compared with those from reference institutions.Materials and methods. A retrospective study of patients under 15 years old undergoing thyroidectomy ± cervical lymphadenectomy by low volume pediatric surgeons (<30 cervical endocrine surgeries annually) in a pediatric hospital from January 2010 to January 2020 was carried out.Results. 11 patients undergoing 12 surgeries (mean age: 9.8 years; 63% female) were analyzed. Thyroid nodules were the main surgical indication (50%), and prevalence of genetic mutations was 45%. 1 patient had transient hypocalcemia, and there were 2 cases of transient recurrent laryngeal nerve neuropraxia (16.6%). No permanent complications were noted. 66.6% of pathological reports showed malignancy. Mean hospital stay was 2.35 days (range: 1.25-5), with an overall complication rate of 25%, similar to that reported by high-volume institutions. After a mean follow-up of 4 years, tumor recurrence has not been observed in any patient.Conclusions. In our view, an experienced pediatric surgeon specialized in pediatric and neonatal general surgery -even if below the high volume threshold -acquires the skills required in pediatric thyroid surgery without an increase in morbidity and mortality. Perioperative management should be agreed and protocolized by the various specialists involved to improve results.

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Section: Discussionsupporting

confidence: 69%

Pediatric thyroidectomy in a "low volume" institution without protocolization: results and future horizons

Moreno-Alfonso¹,

Caballero²,

Martínez³

et al. 2022

Cir Pediatr

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“…Previous studies have successfully applied ACS-NSQIP-P to assess and direct quality improvement in various pediatric otolaryngologic procedures. [20][21][22][23][24][25][26][27] Thus, the primary goal of this study is to investigate the modern perioperative sequelae of laryngeal surgery for LM. In theory, ACS-NSQIP-P allows for greater generalizability of results given both large and diverse patient samples from North America, facilitating adequate statistical power to detect differences between unique patient populations of interest.…”

Section: Introductionmentioning

confidence: 99%

Surgical Intervention for Laryngomalacia: Age-Related Differences in Postoperative Sequelae

Patel

Adkins

Ramadan

et al. 2020

Ann Otol Rhinol Laryngol

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Objective: Identify risk factors and determine perioperative morbidity of children undergoing surgery for laryngomalacia (LM). Methods: A retrospective analysis of the multi-institutional American College of Surgeons National Surgical Quality Improvement Program-Pediatric Database (ACS-NSQIP-P) was performed to abstract patients aged <18 years with LM (ICD-10 code Q31.5) who underwent laryngeal surgery (CPT code 31541) from 2015 to 2017. Analyzed clinical variables include patient demographics, hospital setting, length of stay, medical comorbidities, postoperative complications, readmission, and reoperation. Results: A total of 491 patients were identified, 283 were male (57.6%) and 208 were female (42.4%). The mean age at time of surgery was 1.07 years (range .01-17 years). Younger patients were more likely to undergo surgery in the inpatient setting compared to their counterparts ( P < .001). Infants were more likely to have prolonged duration of days from admission to surgery ( P < .001), days from surgery to discharge ( P < .001), and total length of stay ( P<.0010). Finally, there was no significant difference between age groups with respect to 30-day general surgical complications ( P = .189), with an overall low incidence of reintubation (1.2%), readmission (3.1%), and reoperation (1.6%). Conclusion: This analysis supports laryngeal surgery as a safe surgical procedure for LM. However, younger children are more likely to undergo operative intervention in the inpatient setting, endure delays from hospital admission to surgical intervention, and experience a prolonged length of stay due to their overall medical complexity. Recognition of key factors may assist in optimizing perioperative risk assessment and promote timely procedural planning in this unique pediatric patient subpopulation.

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“…Tanto las lesiones del NLR como la hipocalcemia sucedieron en pacientes mayores de 6 años con campos operatorios amplios pero tejidos fibrosos y distorsionados, lo que sugiere que tales complicaciones estarían relacionadas con la dificultad inherente a la disección y pérdida de la arquitectura tiroidea, con lo cual se suponen unos resultados similares en manos de cualquier cirujano. En esta misma línea, otros aspectos perioperatorios evaluados, como el tiempo operatorio promedio (162,3 minutos) fue similar al descrito en series con más de 700 pacientes (160,9) (10) ; tampoco hubo diferencias entre la estancia hospitalaria y el control analgésico encontrado respecto al reportado por otros autores.…”

Section: Discussionunclassified

Tiroidectomía pediátrica en un centro de "bajo volumen" y sin protocolización: resultados y horizontes

Alfonso¹,

Caballero²,

Martínez³

et al. 2022

Cir Pediatr

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ResumenObjetivos. La tiroidectomía pediátrica es una intervención infrecuente, compleja y con un riesgo elevado de complicaciones. Se evalúa la tasa de complicaciones y resultados oncológicos de la tiroidectomía no protocolizada en un hospital infantil de segundo nivel en comparación con los centros de referencia.Material y métodos. Estudio retrospectivo de los pacientes menores de 15 años sometidos a tiroidectomía ± disección ganglionar cervical por cirujanos pediátricos de bajo volumen (< 30 cirugías endocrinas cervicales/año) entre enero de 2010 y enero de 2020 en un hospital infantil.Resultados. Se analizaron once pacientes sometidos a 12 procedimientos quirúrgicos (edad media 9,8 años, 63% niñas). Los nódulos tiroideos fueron la principal indicación quirúrgica (50%) y la prevalencia de mutaciones genéticas en la serie fue del 45%. Un paciente presentó hipocalcemia transitoria y hubo 2 casos de neuropraxia transitoria del nervio laríngeo recurrente (16,6%). No hubo complicaciones permanentes. El 66,6% de los informes anatomopatológicos mostraron malignidad. La estancia hospitalaria media fue de 2,35 días (rango 1,25-5) con una tasa global de complicaciones del 25%, similar a la reportada por centros de alto volumen. Después de un seguimiento medio de 4 años, ningún paciente ha presentado recidiva tumoral.Conclusiones. Sugerimos que un cirujano infantil con experiencia en cirugía pediátrica general y neonatal, a pesar de no superar el umbral de alto volumen, adquiere las facultades para realizar la cirugía tiroidea pediátrica sin aumento de morbilidad y mortalidad. El manejo perioperatorio debe ser consensuado entre los diversos especialistas involucrados y protocolizado para mejorar los resultados.

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Pediatric Thyroidectomy: NSQIP-P Analysis of Adverse Perioperative Outcomes

Cited by 16 publications

References 30 publications

Pediatric thyroidectomy in a "low volume" institution without protocolization: results and future horizons

Pediatric thyroidectomy in a "low volume" institution without protocolization: results and future horizons

Surgical Intervention for Laryngomalacia: Age-Related Differences in Postoperative Sequelae

Tiroidectomía pediátrica en un centro de "bajo volumen" y sin protocolización: resultados y horizontes

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