Quality assurance study of benign and malignant goiter. Prospective multicenter data collection regarding 7,617 patients

Abstract

A quality control study was undertaken on 7,265 patients with benign goitre and 352 patients with malignant goitre who were surgically treated between 1.1.98 and 31.12.98. 3 hospital groups were defined according to surgical workload: Group 1: < 50 operations/yr; Group 2: 50-150 operations/yr; Group 3: > 150 operations/yr. The temporary rate of recurrent laryngeal nerve (RLN) palsies for benign goitre was 3.9% and the permanent 1.1%. For malignant goitre the rates were 12.8% and 6.8% respectively. The rate of temporary (p < 0.040) and permanent (0.003) palsies after surgery for benign goitre was lower in group 3 compared to group 1 and 2. There were too few cases for statistical analysis of the malignant goitres. After benign goitre surgery a transient hypocalcaemia rate of 6.3% and a permanent of 1.1% were observed. For malignant goitre the incidence was 23.8% and 7.1%, respectively. A significantly increased rate of permanent hypocalcaemia (p < 0.003) was demonstrated in group 3 after surgery for multinodular goitre. Centres in group 3 made more extended (smaller thyroid remnants) resections (p < 0.01) with the equivalent rate of general complications. The average inpatient stay for malignant goitres was 13.1 days and for benign goitres 8.7 days. On average, patients with bilateral resections for benign goitre stayed 0.4 days longer in hospital than those with unilateral procedures. Prophylactic antibiotics were administered to 2.1% of patients and 94.6% received thrombosis prophylaxis.