Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA.
Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
J Surg Oncol. 2023 Jul;128(1):16-22. doi: 10.1002/jso.27264. Epub 2023 Apr 10.
Pediatric thyroidectomy (PT) is an uncommon procedure with a risk of significant morbidity. This study utilizes a national database to identify factors associated with short-term (30-day) post-thyroidectomy complications in children with thyroid cancer.
The 2016 and 2012 Kids' Inpatient Databases (KID) were used in this study. All children with thyroid cancer undergoing thyroidectomy were included. Complications were categorized into endocrine, nervous, pulmonary, and other. Hospital volume was stratified into high-volume (performing the top 10% of total cases, HVC) or non-high-volume centers (NHVC). Risk factors were analyzed using univariable and multivariable statistical tests.
Six hundred and sixty-three patients with an average age of 15.93 years met inclusion criteria. Most patients were seen in an NHVC (90.0%) and 37.3% of thyroidectomies were performed with neck dissections. The incidence of any complication was 32.1%. Endocrine complications were the most frequent (32.7%). Independent predictors of any or only endocrine complications were age (odds ratio [OR] = 0.927, p = 0.002, any; OR = 0.926, p = 0.003, endocrine) or concurrent neck dissection (OR = 1.679, p = 0.004, any; OR = 1.683, p = 0.005, endocrine). There was no statistically significant change in odds with hospital volume.
Further investigation into the effect of single surgeon versus hospital volume on the risk of complications in pediatric thyroid cancer surgery is warranted.
小儿甲状腺切除术（PT）是一种罕见的手术，存在发生重大并发症的风险。本研究利用国家数据库确定与儿童甲状腺癌患者甲状腺切除术后 30 天内（短期）并发症相关的因素。
本研究使用了 2016 年和 2012 年的儿科住院患者数据库（KID）。所有接受甲状腺切除术的甲状腺癌患儿均纳入研究。并发症分为内分泌、神经、肺部和其他类型。根据医院手术量将医院分为高容量（完成所有病例的前 10%，HVC）或非高容量中心（NHVC）。使用单变量和多变量统计检验分析危险因素。
663 名平均年龄为 15.93 岁的患者符合纳入标准。大多数患者在 NHVC 就诊（90.0%），37.3%的甲状腺切除术伴颈部清扫术。任何并发症的发生率为 32.1%。内分泌并发症最常见（32.7%）。任何并发症或仅内分泌并发症的独立预测因素是年龄（比值比[OR] = 0.927，p = 0.002，任何；OR = 0.926，p = 0.003，内分泌）或同期颈部清扫术（OR = 1.679，p = 0.004，任何；OR = 1.683，p = 0.005，内分泌）。医院手术量与并发症发生几率之间无统计学显著差异。
有必要进一步研究单外科医生和医院手术量对儿童甲状腺癌手术并发症风险的影响。
