Kang Il Ku, Bae Ja Seong, Kim Jeong Soo, Kim Kwangsoon
Department of Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea.
Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Ann Surg Treat Res. 2024 Mar;106(3):140-146. doi: 10.4174/astr.2024.106.3.140. Epub 2024 Feb 22.
Recurrent laryngeal nerve injury after thyroid surgery may cause vocal cord palsy (VCP), which leads to unexpected additional costs. In recent years, intraoperative neural monitoring (IONM) has been used to lower the incidence rate of VCP. This study aimed to analyze postoperative management costs for patients with papillary thyroid carcinoma (PTC).
We analyzed the medical records of patients who underwent lobectomy for PTC from September 2018 to August 2019 at The Catholic University of Korea, Seoul St. Mary's Hospital. A total of 411 patients were enrolled and all the patients had voice examinations. We investigated the total costs in the IONM and non-IONM groups during a maximum 1-year follow-up and calculated the additional costs due to VCP by subtraction of the mean values in each group.
The incidence rate of VCP was 3.9% (16 of 411). Extrathyroidal extension was related to VCP in Cox regression tests and accounted for 3.2% (13 of 411). VCP rate did not show a significant difference between the IONM and non-IONM groups (4.1% 3.8%, P = 0.883). Total costs for postoperative management were higher in the IONM group than in the non-IONM group (US $328.2 ± $220.1 $278.7 ± $141.4, P < 0.05). However, the additional costs due to VCP were significantly lower in the IONM group than in the non-IONM group ($474.1 ± $150.3 $568.9 ± $367.6, P < 0.005).
The use of IONM can mitigate the increase in costs by saving additional expenses associated with VCP.
甲状腺手术后喉返神经损伤可能导致声带麻痹（VCP），进而产生意想不到的额外费用。近年来，术中神经监测（IONM）已被用于降低VCP的发生率。本研究旨在分析甲状腺乳头状癌（PTC）患者的术后管理费用。
我们分析了2018年9月至2019年8月在韩国天主教大学首尔圣母医院接受PTC肺叶切除术患者的病历。共纳入411例患者，所有患者均进行了嗓音检查。我们调查了IONM组和非IONM组在最长1年随访期间的总费用，并通过减去每组的平均值计算出VCP导致的额外费用。
VCP的发生率为3.9%（411例中的16例）。在Cox回归检验中，甲状腺外侵犯与VCP相关，占3.2%（411例中的13例）。IONM组和非IONM组的VCP发生率无显著差异（4.1%对3.8%，P = 0.883）。IONM组的术后管理总费用高于非IONM组（328.2美元±220.1美元对278.7美元±141.4美元，P < 0.05）。然而，IONM组因VCP导致的额外费用显著低于非IONM组（474.1美元±150.3美元对568.9美元±367.6美元，P < 0.005）。
使用IONM可以通过节省与VCP相关的额外费用来减轻成本增加。
