Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia.
Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia.
J Surg Res. 2021 Apr;260:210-219. doi: 10.1016/j.jss.2020.11.008. Epub 2020 Dec 23.
Although complication rates after thyroidectomy are well described in the literature, the timing of these events is less understood. This study delineates the timeline and risk factors for early adverse events after thyroidectomy.
This study included a retrospective review of 161,534 patients who underwent thyroidectomy between 2005 and 2018 using the American College of Surgeons National Surgical Quality Improvement Program database. Time to specific complications was analyzed for all patients undergoing thyroidectomy, with further stratification of hemithyroidectomy and total thyroidectomy cohorts. Univariate analyses were conducted to analyze demographics, preoperative comorbidities, and complications. A multivariate logistic regression model was generated to identify significant risk factors for 7-day postoperative complications.
The overall complication rate was 3.28%. A majority of complications arose before discharge including the following: blood transfusion (96%), hematoma formation (68%), pneumonia (53%), and cardiac arrest (67%). Approximately 37% of unplanned reoperations occurred before discharge in the hemithyroidectomy versus 63% in the total thyroidectomy cohort. Greater than 65% of mortalities occurred after discharge in both groups. Complications generally occurring within 7 d for the entire cohort included the following: pneumonia (3; 2-8 [median postoperative day; interquartile range]), pulmonary embolism (6; 2-12), cardiac arrest (1; 0-5), myocardial infarction (2; 1-6), blood transfusions (0; 0-1), and hematoma formation (0; 0-2). Superficial surgical site infection (9; 6-16) occurred later. Patients who underwent outpatient surgery had a decreased risk of complications (odds ratio 0.41) in the 7-day postoperative period.
Although early complications after thyroidectomy are rare, they have a distinct time course, many of which occur after discharge. However, in selected patients undergoing outpatient thyroidectomy, overall risk of complications is decreased. Understanding timing helps establish better preoperative communication and education to improve postoperative expectations for the provider and patient.
尽管甲状腺切除术的并发症发生率在文献中已有详细描述，但这些事件的发生时间了解甚少。本研究描绘了甲状腺切除术后早期不良事件的时间进程和风险因素。
本研究回顾性分析了 2005 年至 2018 年间使用美国外科医师学院国家外科质量改进计划数据库行甲状腺切除术的 161534 例患者。对所有甲状腺切除术患者的特定并发症发生时间进行分析，并对甲状腺半切除术和甲状腺全切除术队列进行进一步分层。进行单变量分析以分析人口统计学、术前合并症和并发症。生成多变量逻辑回归模型，以确定 7 天术后并发症的显著风险因素。
总体并发症发生率为 3.28%。大多数并发症在出院前发生，包括输血（96%）、血肿形成（68%）、肺炎（53%）和心脏骤停（67%）。甲状腺半切除术组中约 37%的计划外再次手术发生在出院前，而甲状腺全切除术组中则为 63%。两组的死亡率大多发生在出院后，超过 65%。对于整个队列，7 天内通常发生的并发症包括以下内容：肺炎（3 例；2-8[中位术后天数；四分位间距]）、肺栓塞（6 例；2-12）、心脏骤停（1 例；0-5）、心肌梗死（2 例；1-6）、输血（0 例；0-1）和血肿形成（0 例；0-2）。浅表手术部位感染（9 例；6-16）发生较晚。在 7 天术后期间，门诊手术患者的并发症风险降低（优势比 0.41）。
尽管甲状腺切除术后早期并发症罕见，但它们具有独特的时间进程，其中许多发生在出院后。然而，在接受门诊甲状腺切除术的选定患者中，整体并发症风险降低。了解时间进程有助于建立更好的术前沟通和教育，从而提高提供者和患者对术后的期望。
