Thyroid and Parathyroid Surgery: The General Otolaryngologist Experience

Abstract

Objectives/Hypothesis Previous studies on complication rates of thyroid and parathyroid surgery focus on cases performed by general surgeons and fellowship trained head and neck or endocrine surgeons. This study examines the complication rate of thyroid and parathyroid surgery performed by a non-fellowship trained general otolaryngologist and compares it to rates reported by general surgeons and fellowship trained endocrine surgeons. Study Design Retrospective chart review. Methods We reviewed 96 cases of thyroidectomy and/or parathyroidectomy performed between 2002 and 2010 by a general otolaryngologist. Data collected included patient age, sex, ultrasound scans, fine needle aspiration results, surgical time, nerve monitor use, drain use, estimated blood loss, pathology, calcium levels, recurrence, vocal cord paresis, complications and mortality. Results We found comparable rates of hypocalcemia, vocal cord paralysis, scar formation and hematoma when compared to previously published studies. Nine patients (9.3%) had transient hypocalcemia and no patients developed permanent hypocalcemia. One patient (1.0%) had temporary vocal cord paresis lasting less than 6 months, and one patient (1.0%) had permanent unilateral vocal cord paralysis secondary to sacrifice of the recurrent laryngeal nerve. Two patients (2.0%) developed keloid scars. One patient (1.0%) underwent reoperation for evacuation of a postoperative hematoma. These rates are within or below the ranges reported in the aforementioned literature. One patient (1.0%) developed a wound infection treated with antibiotics. There were no airway complications, chyle leaks, or deaths. Conclusions This study reports a favorable complication rate and supports the safety of thyroid and parathyroid surgery performed by a general otolaryngologist. INTRODUCTION Complications of thyroid and parathyroid surgery include metabolic derangements, superior and recurrent laryngeal nerve injury, infection, airway compromise and bleeding. Various factors have been implicated as risks for complication in thyroid and parathyroid surgery. Studies performed by general surgeons or fellowship trained endocrine surgeons have suggested that surgeon volume1-3, size of goiter, presence of thyroid carcinoma, stage of disease, and extent of resection may be related to risk of complications.4,5 In recent years, a greater percentage of thyroid and parathyroid operations are being performed by otolaryngologists as opposed to general surgeons.6,7 This study examines the complication rate of thyroid and parathyroid surgery performed by a general otolaryngologist who performs, on average, 12 cases per year over an eight year period. This study was completed in order to provide further guidance as to the safety of thyroid and parathyroid surgery performed by a general otolaryngologist. MATERIALS AND METHODS After obtaining approval from the institutional review board, we performed a retrospective chart review of patients who underwent thyroidectomy and/or parathyroidectomy by Dr. Erich Voigt at the New York Otolaryngology Institute and the Department of Otorhinolaryngology/Head & Neck Surgery of Weill Cornell Medical College between January 2002 and September 2010. Patients all had at least one postoperative visit. Information such as diagnosis, type of surgery performed, age, sex, pathologic diagnosis, surgical time, use of nerve monitor, use of drains, estimated blood loss, parathyroid hormone levels, preoperative and postoperative calcium levels, calcium and vitamin D supplementation, readmission, recurrence, vocal cord paresis, complications and mortality were recorded.