Current Practice of Surgery for Benign Goitre-An Analysis of the Prospective DGAV StuDoQ|Thyroid Registry.

Detlef Bartsch,Theresia Weber,Kerstin Lorenz,Carsten Klinger,Christian Vorländer,Andreas Zielke,Cornelia Dotzenrath,Heinz Buhr

doi:10.3390/jcm8040477

Abstract

Background: To evaluate the current indications, resection strategies and short-term outcomes of surgery for benign goitre in a country with endemic goitre. Methods: Data of patients who underwent surgery for benign goitre were retrieved from the prospective StuDoQ/Thyroid registry and retrospectively analysed regarding the patient’s demographics, indications for surgery, surgical procedures, histology, and perioperative outcomes. Results: In a 15-month period, 12,888 patients from 83 departments underwent thyroid resections for benign conditions. Main indications for surgery were exclusion of malignancy (68%), compression symptoms (20.7%) and hyperthyroidism (9.7%). Preoperative fine needle aspiration cytology was performed in only 12.2% of patients with the indication “exclusion of malignancy”. Thyroidectomy (49.8%) or hemithyroidectomy (36.9%) were performed in 86.7% of patients. Minimally invasive or alternative surgical techniques were applied in only 2.2%. Intraoperative neuromonitoring was used in 98.4% of procedures, in 97.5% of patients at least one parathyroid gland was visualized, and in 15.3% of patients parathyroid tissue was autografted, respectively. The rates of unilateral and bilateral transient recurrent nerve palsy were 3.6% and 0.07% of nerves at risk, the rate of transitory hypoparathyroidism was 15.3%. The rates of postoperative bleeding and wound infections requiring reoperation were 1.4% and 0.07%, respectively. Conclusions: The indication “exclusion of malignancy” is made too liberally, and there is a strong attitude to perform complete thyroid resections. Postoperative hypoparathyroidism is the major complication after surgery for benign thyroid disease, thus requiring more awareness.

Highlights

Germany is an endemic goitre area and thyroid resections are among the most frequent visceral operations, with approx. 70,000 procedures being carried out per year [1,2]
Relevant outcome and quality indicators were selected on the basis of the German S2k guidelines [3,4,5] for the surgical treatment of benign and malignant goitre, the certification guidelines for competence centres for thyroid/parathyroid surgery of the DGAV, and the EUROCRINE registry. 52 parameters were defined by a browser-based electronic case report form
A total of 17,702 patients from 83 surgical departments were entered into the StuDoQ/Thyroid Registry in the first 15 months

Summary

Introduction

Germany is an endemic goitre area and thyroid resections are among the most frequent visceral operations, with approx. 70,000 procedures being carried out per year [1,2]. Health data of insured persons are increasingly evaluated by health insurances to evaluate the quality and practice of thyroid surgery and to make it transparent to the public [8,9] It has been shown by a retrospective analysis of insurance data that only 9% of patients with thyroid resections underwent preoperative calcitonin screening [8], suggesting that actual guideline recommendations [3,4,5,6,7] are not fully implemented in daily practice. Methods: Data of patients who underwent surgery for benign goitre were retrieved from the prospective StuDoQ/Thyroid registry and retrospectively analysed regarding the patient’s demographics, indications for surgery, surgical procedures, histology, and perioperative outcomes. Postoperative hypoparathyroidism is the major complication after surgery for benign thyroid disease, requiring more awareness

Methods

Results

Conclusion