Thyroidectomy Complications in Patients with Diabetes Mellitus

Abstract

Objective To (1) analyze postoperative thyroidectomy outcomes in patients with diabetes mellitus (DM), who are prone to deleterious effects of glucose dysmetabolism, and (2) apply findings to optimize perioperative management of diabetics requiring thyroid surgery. Study Design Retrospective database analysis. Setting University hospital. Subjects and Methods The National Inpatient Sample was queried using International Classification of Diseases, Ninth Revision, Clinical Modification and Procedure Coding System (PCS) codes for patients with benign or malignant thyroid disease who underwent thyroid surgery between 2002 and 2013. An analysis of demographics, comorbidities, and postoperative outcomes was conducted between a DM vs non-DM cohort using bivariate and multivariate techniques. Results In total, 103,842 cases met inclusion criteria; 14.2% were diabetics. Diabetics had significantly higher rates of baseline comorbid chronic pulmonary disease, hypertension, obesity, and anemia. Following thyroidectomy, patients with DM were more likely to have vocal cord paresis or paralysis compared to non-DM patients (2.0% vs 1.3%; P < .001). However, when adjusting for demographics and comorbidities, there was no significant difference in this complication between the 2 groups. Diabetics had independently higher rates of cardiac, pulmonary, and urinary complications, as well as transfusion, reintubation, and in-hospital mortality. Diabetics had longer hospital stays (2.76 vs 1.97; P < .001) with higher incurred hospital charges (32,921 vs 25,198; P < .001). Conclusion Although DM often confers metabolic and ischemic derangements secondary to hyperglycemia such as neuropathy, this comorbidity was not independently associated with higher rates of vocal cord paresis or paralysis following thyroid surgery. However, DM predicted other adverse outcomes, including greater cardiac, pulmonary, and urinary complications, as well as transfusion, reintubation, and in-hospital mortality.

Impact of Diabetes Mellitus Following Tonsillectomy in Adults: A National Surgical Quality Improvement Program Analysis

“…Results described in this study coincide with findings in other otolaryngology procedures. [31][32][33] DM was found to be an independent predictor of infectious, pulmonary, and cardiac complications resulting in extended length of stay after thyroidectomy. 33 IDDM patients in particular, when compared to NIDDM patients, had increased morbidity after undergoing free flap surgery.…”

“…[31][32][33] DM was found to be an independent predictor of infectious, pulmonary, and cardiac complications resulting in extended length of stay after thyroidectomy. 33 IDDM patients in particular, when compared to NIDDM patients, had increased morbidity after undergoing free flap surgery. 31 This highlights information provided by The American Diabetes Association (ADA) stating that diabetics are at increased risk for hospitalizations with elongated length of stay, which leads to a higher burden on health care costs.…”

Diabetes mellitus in major head and neck cancer surgery: Systematic review and meta‐analysis

“…Although the exact mechanism by which DM impairs wound healing remains to be fully described, this disease has been associated with increased risks of adverse outcomes across a wide range of surgeries, 5,31 and its role in the setting of H&N cancer surgeries is one which warranted further investigation. This systematic review identified 16 studies which met inclusion criteria.…”

“…Several studies have suggested decreased levels of proangiogenic signals, such as vascular endothelial growth factor, or increased levels of anti-angiogenic signals, such as pigment epithelium-derived factor (PEDF), may be involved in this process. 30 Although the exact mechanism by which DM impairs wound healing remains to be fully described, this disease has been associated with increased risks of adverse outcomes across a wide range of surgeries, 5,31 and its role in the setting of H&N cancer surgeries is one which warranted further investigation. This systematic review identified 16 studies which met inclusion criteria.…”

Importance of proper diet after thyroidectomy in diabetic patients: A short communication

“…In their research study, Chung et al (2019) showed that diabetes patients exhibited considerably more significant rates of concomitant chronic pulmonary illness, hypertension, obesity, and anemia at the start of the study. Patients with DM were more likely than non-DM patients to have vocal cord paresis or paralysis after thyroid surgery (2% vs. 1.3%; P value=.001).…”