Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Ann Surg Oncol. 2011 Dec;18(13):3551-8. doi: 10.1245/s10434-011-1938-2. Epub 2011 Jul 20.
To assess whether perioperative surgical outcomes associated with thyroid operations were different in those with benign or malignant conditions, we queried the NSQIP, a multi-institutional, risk-adjusted, prospective U.S. database.
A total of 10,838 patients who underwent initial thyroid surgery as their principal operation during 2005-2007 were analyzed. Analysis focused on demographics, preoperative risk factors, operative details, postoperative complications, return to the operating room, and length of surgical stay.
Thirty-three percent of patients had a postoperative diagnosis of malignancy. Mean operating time was 121.8 min (119.3 min benign, 123.0 min malignant, P = .004) and average length of stay 1.16 days (1.12 days benign, vs. 1.21 days malignant, P = .007). Overall morbidity (return to the operating room plus medical complications) was 3.8% for the entire cohort, significantly higher in patients with malignant disease (4.9 vs. 3.3%, respectively, P < .001). On multivariate analysis, American Society of Anesthesiologists class, congestive heart failure (odds ratio [OR] 6.83, 95% confidence interval [CI] 1.81-25.80), dyspnea, and return to the operating room (OR 5.41, 95% CI 3.1-9.45) were significant risk factors for complications, while malignant disease (OR 2.25, 95% CI 1.75-2.9), outpatient status (OR 3.16, 95% CI 2.4-4.17), and other complications (OR 6.46, 95% CI 3.61-11.54) were risk factors for returning to the operating room.
Patients undergoing thyroid surgery for malignancy have a longer length of stay (1.21 days), longer operation times, and return to the operating room at higher rates compared to those with benign disease. Malignancy itself is only an independent risk factor for return to the operating room and not other complications; surgeons may consider keeping those patients overnight for observation.
为了评估甲状腺手术围手术期结局在良性和恶性疾病患者中是否存在差异，我们查询了 NSQIP，这是一个多机构、风险调整、前瞻性的美国数据库。
分析了 2005 年至 2007 年间初次甲状腺手术作为主要手术的 10838 例患者。分析重点是人口统计学、术前危险因素、手术细节、术后并发症、重返手术室和手术住院时间。
33%的患者术后诊断为恶性肿瘤。平均手术时间为 121.8 分钟（良性 119.3 分钟，恶性 123.0 分钟，P=.004），平均住院时间为 1.16 天（良性 1.12 天，恶性 1.21 天，P=.007）。整个队列的总发病率（重返手术室加医疗并发症）为 3.8%，恶性疾病患者显著更高（分别为 4.9%和 3.3%，P <.001）。多因素分析显示，美国麻醉医师协会（ASA）分级、充血性心力衰竭（比值比 [OR] 6.83，95%置信区间 [CI] 1.81-25.80）、呼吸困难和重返手术室（OR 5.41，95% CI 3.1-9.45）是并发症的显著危险因素，而恶性疾病（OR 2.25，95% CI 1.75-2.9）、门诊状态（OR 3.16，95% CI 2.4-4.17）和其他并发症（OR 6.46，95% CI 3.61-11.54）是重返手术室的危险因素。
与良性疾病患者相比，因恶性疾病接受甲状腺手术的患者住院时间（1.21 天）更长，手术时间更长，重返手术室的比例更高。恶性肿瘤本身仅是重返手术室的独立危险因素，而不是其他并发症的危险因素；外科医生可能会考虑让这些患者留院观察。
