Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Head and Neck Institute, The Cleveland Clinic, Cleveland, OH, USA.
Ann Otol Rhinol Laryngol. 2021 Dec;130(12):1351-1359. doi: 10.1177/00034894211007219. Epub 2021 Apr 9.
To assess risk factors and non-thyroid specific postoperative complications for thyroid lobectomy compared to total thyroidectomy.
A retrospective, cross-sectional study of adults undergoing a lobectomy or total thyroidectomy using the National Surgical Quality Improvement Program database between 2005 and 2017. Patients not treated by otolaryngologists or general surgeons and with unknown demographic variables were excluded.
A total of 106 915 patients were analyzed, 64 763 total thyroidectomies and 42 152 lobectomies. Multivariable analysis demonstrated that total thyroidectomy patients were half as likely to return to the operating room (OR = 0.491 (95%CI 0.445-0.542), < .001). Within this cohort, patients at greater risk for reoperation had a history of hypertension (OR = 1.225 (95%CI 1.090-1.376), < .001), a malignant pathology (OR = 1.921 (95%CI 1.734-2.128), < .001), and smoked (OR = 1.237 (95%CI 1.087-1.407), = .001). Conversely, diabetes and body mass index did not impact the rate of reoperation when assessing total thyroidectomy and lobectomy. The most frequent non-thyroid specific complications in total thyroidectomy were unplanned intubation (0.5%), urinary tract infection (0.3%), and superficial surgical site infection (0.3%). In thyroid lobectomy, the most common complications were superficial surgical site infection (0.3%) and urinary tract infection (0.2%).
Our multi-institutional study indicates specific risk factors for returning to the operating room that may warrant closer follow up after surgery for total thyroidectomy or thyroid lobectomy. We also identified the most common post-operative complications. During pre-operative planning, these findings should be considered by thyroid surgeons to help mitigate risk to patients.
评估甲状腺叶切除术与甲状腺全切除术相比的非甲状腺特异性术后并发症的危险因素。
本研究为回顾性、横断面研究，纳入了 2005 年至 2017 年期间在国家手术质量改进计划数据库中接受甲状腺叶切除术或甲状腺全切除术的成年人患者。排除未接受耳鼻喉科医生或普通外科医生治疗以及无法获取人口统计学变量的患者。
共分析了 106915 例患者，其中甲状腺全切除术 64763 例，甲状腺叶切除术 42152 例。多变量分析表明，甲状腺全切除术患者再次手术的可能性是甲状腺叶切除术的一半（OR=0.491（95%CI 0.445-0.542），<0.001）。在这一队列中，有更高再次手术风险的患者有高血压病史（OR=1.225（95%CI 1.090-1.376），<0.001）、恶性病理（OR=1.921（95%CI 1.734-2.128），<0.001）和吸烟史（OR=1.237（95%CI 1.087-1.407），=0.001）。相反，在评估甲状腺全切除术和甲状腺叶切除术时，糖尿病和体重指数并不影响再次手术的发生率。甲状腺全切除术最常见的非甲状腺特异性并发症是计划性插管（0.5%）、尿路感染（0.3%）和浅表手术部位感染（0.3%）。在甲状腺叶切除术中，最常见的并发症是浅表手术部位感染（0.3%）和尿路感染（0.2%）。
我们的多机构研究表明，甲状腺全切除术再次手术的特定危险因素可能需要在手术后更密切地随访。我们还确定了最常见的术后并发症。在术前规划中，甲状腺外科医生应考虑这些发现，以帮助降低患者的风险。
