Abstract
BackgroundHypocalcemia and nerve injury are the most severe complications after thyroid surgery. The duration of surgery has not been previously considered as a risk factor for postoperative complications in patients undergoing total thyroidectomy. We sort to investigate the influence of prolonged surgery on postoperative complications in patients undergoing total thyroidectomy.MethodsWe hypothesized that a threshold of > 120 minutes of surgical time could represent a surrogate marker for postoperative complications in patients undergoing total thyroidectomy for benign thyroid disorders. The study population was divided into two groups based on the median duration of surgery (120 min): group I ≤ 120 minutes (control group), group II > 120 minutes (study group). The charts of eligible patients undergoing total thyroidectomy within a six-year period from January 1st 2006 to December 31st 2012 were reviewed. The primary outcomes included the rates postoperative hypocalcemia and recurrent laryngeal nerve palsy. The secondary outcomes included the rates of postoperative hemorrhage, wound dehiscence and length of hospital stay.Results305 cases of thyroidectomy were included for analysis; 130 (42.6%) control group and 175 (57.4%) study group. Transient (15.4% vs 19.4%) and permanent (3.8% vs. 2.9%) hypocalcemia were recorded in control and study group respectively. The incidence of nerve palsy was 1.5% in the control group and 1.4% in the study group. The mean length of postoperative hospital stay was 3d in both groups. There was no significant difference amongst both groups with regard to postoperative bleeding (p = 0.57) and wound dehiscence (p = 0.31). Prolonged surgery (> 120 min) was not identified as a risk factor for increased postoperative complication.ConclusionProlonged duration of surgery > 120 minutes is not a surrogate marker for postoperative complications in patients undergoing total thyroidectomy.
Highlights
Hypocalcemia is the most common complication following thyroid surgery
Peri-operative data including the indication for surgery, duration of surgery, postoperative complications, postoperative hospital stay, removal and re-implantation of parathyroid glands were retrieved from surgical documentation sheets, surgeon’s notes and discharge records
We hypothesized that a threshold of > 120 minutes of surgical time could represent a surrogate marker for postoperative complications in patients undergoing total thyroidectomy for benign thyroid disorders
Summary
Hypocalcemia is the most common complication following thyroid surgery. Hemodilution, surgical trauma, removal of one or more parathyroid glands as well as devascularization of the parathyroid glands following ligation of the thyroid vessels have been identified as possible causes of postoperative hypocalcemia [12-15]. Apart from hypocalcemia, recurrent laryngeal nerve injury (RLNI) is the most severe complication following thyroid surgery [16-19]. Besides visual identification of the recurrent laryngeal nerve (RLN), intraoperative monitoring has been shown to reduce the risk of RLNI [20,21]. Hypocalcemia and nerve injury are the most severe complications after thyroid surgery. The duration of surgery has not been previously considered as a risk factor for postoperative complications in patients undergoing total thyroidectomy. We sort to investigate the influence of prolonged surgery on postoperative complications in patients undergoing total thyroidectomy
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