14. “TEXTBOOK OUTCOMES” IN SURGICAL APPROACH OF DIFFERENTIATED THYROID CANCER

Abstract

Abstract Introduction The textbook outcome (TO) is a composite quality measure used to define the achievement of multiple ideal surgical results. There is a lack of studies regarding TO in differentiated thyroid carcinoma (DTC). The aim of the study is to define the TO in DTC surgery and determine the factors that avoid its achievement. Methods Retrospective study of consecutive patients undergoing surgery for DTC between 01/01/2021 and 31/03/2023. The TO is defined by the absence of complications (hematoma, recurrent laryngeal nerve palsy, hypocalcemia, seroma, surgical site infection (SSI)), prolonged hospital stay (exceeding the 75th percentile), readmission, and 90-day mortality. Results Fifty-nine patients were included (median age 53 years (43-61), 43 women (72,9%)) with a median follow-up of 17 months (14-20). The majority presented with unilateral nodules (32; 54,2%), Bethesda VI (24; 44,4%), with a median size of 21mm (11,75-35,0). Thirty-one patients (52,5%) underwent total thyroidectomy, 28(47,5%) lobectomy, 15 unilateral CCL (25,4%), 10 bilateral CCL (16,9%) and 10 unilateral LCL (16,9%). The median hospital stay was 1 day (1-1). Fourteen patients (23,7%) had complications: 1 hematoma (1,7%), 5 hoarseness (8,5%), 4 transient recurrent nerve palsy (6,8%) and 2 permanent (3,4%), 7 transient hypocalcemia (11,9%) and 4 permanent (6,8%), 2 SSI (3,4%) and 3 seroma (5,1%). Two patients were readmitted because of SSI (one requiring emergency surgery). In total, 69,5% (41) patients achieved TO. Risk factors that avoided its consecution were: total thyroidectomy [OR7,81 IC95%(1,95-31,25); p=0,004)] and unilateral LCL [OR4,63 IC95%(1,12-19,20); p=0,035)]. Conclusion Most of the patients achieved TO. The predictors associated to the absence of TO achievement were total thyroidectomy and unilateral LCL, meaning that the more aggressive the surgery is, the greater the chances are of surgical complications.