The preoperative evaluation prevent the postoperative complications of thyroidectomy

Chien Feng Huang, Yachung Jeng, Kuo Dong Chen, Ji Kuen Yu, Chao Ming Shih, Shih-Ming Huang, Chen Hsen Lee, Fong Fu Chou, Ming Lang Shih, Kee Ching Jeng, Tzu Ming Chang

Research output: Contribution to journalArticle

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Abstract

Thyroid surgery is generally a safe surgery but its complications are still common. We wish to identify preoperative factors that predict postoperative complications. Methods: A nationwide survey was conducted by senior surgeons from 16 medical centers and 5 regional hospitals in Taiwan to thyroid operations performed over 3 years. 3846 cases were retrospectively examined to identify factors influencing complications: indication for surgery, preoperative evaluation, such as ultrasonography, chest X-ray, computed tomography and magnetic resonance imaging, isotope scanning, fine-needle aspiration cytology (FNAC) and thyroid function test, and patient characteristics. Results: Eighty-four percent of patients were female. Seven percent of the patients had immediate postoperative hypocalcemia (mild and severe) and 2.3%, hoarseness (recurrent laryngeal nerve (RLN) injury, temporary/permanent). Logistic regression analysis identified an association between hypocalcemia and RLN injury with age, hospital category, surgical procedure types (total thyroidectomy, unilateral, bilateral subtotal or total resection). A lower incidence of hypocalcemia was related to preoperative neck ultrasound and FNAC analysis (the odds ratio (OR)=0.5 and 0.65, [95% confidence interval (CI) 0.331-0.768 and 0.459-0.911], P=0.0014 and 0.0127, respectively), while RLN injury was not associated with any preoperative evaluation. The ORs of hypocalcemia and RLN injury for patients older than 50 years were 0.55 and 2.15, [0.393-0.763 and 1.356-3.4], P<0.001 and 0.0012, respectively. Conclusions: The success of thyroid surgery depends on careful preoperative planning, including a preoperative neck ultrasound to determine the proximity of the nodule to the recurrent laryngeal nerve course, and the consideration of the type of anesthesia, adjuvant devices for intra-op monitoring of the RLN, and surgical modalities. Our results suggest that preoperative evaluation implementations are positively associated with strategy of surgery and postoperative hypocalcemia prevention. •Thyroid surgery depends on careful preoperative planning.•Evaluation for lesions, adjuvant devices, and surgical modalities are important.•Preoperative evaluation affects the hypocalcemia.•Intraoperative monitor may reduce RLN injury.

Original languageEnglish
Pages (from-to)5-10
Number of pages6
JournalAnnals of Medicine and Surgery
Volume4
Issue number1
DOIs
Publication statusPublished - 2015 Mar 1

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Recurrent Laryngeal Nerve Injuries
Hypocalcemia
Thyroidectomy
Thyroid Gland
Recurrent Laryngeal Nerve
Fine Needle Biopsy
Cell Biology
Anesthesia Adjuvants
Neck
Thyroid Function Tests
Hoarseness
Equipment and Supplies
X Ray Computed Tomography
Taiwan
Isotopes
Ultrasonography
Thorax
Logistic Models
Odds Ratio
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Huang, Chien Feng ; Jeng, Yachung ; Chen, Kuo Dong ; Yu, Ji Kuen ; Shih, Chao Ming ; Huang, Shih-Ming ; Lee, Chen Hsen ; Chou, Fong Fu ; Shih, Ming Lang ; Jeng, Kee Ching ; Chang, Tzu Ming. / The preoperative evaluation prevent the postoperative complications of thyroidectomy. In: Annals of Medicine and Surgery. 2015 ; Vol. 4, No. 1. pp. 5-10.
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title = "The preoperative evaluation prevent the postoperative complications of thyroidectomy",
abstract = "Thyroid surgery is generally a safe surgery but its complications are still common. We wish to identify preoperative factors that predict postoperative complications. Methods: A nationwide survey was conducted by senior surgeons from 16 medical centers and 5 regional hospitals in Taiwan to thyroid operations performed over 3 years. 3846 cases were retrospectively examined to identify factors influencing complications: indication for surgery, preoperative evaluation, such as ultrasonography, chest X-ray, computed tomography and magnetic resonance imaging, isotope scanning, fine-needle aspiration cytology (FNAC) and thyroid function test, and patient characteristics. Results: Eighty-four percent of patients were female. Seven percent of the patients had immediate postoperative hypocalcemia (mild and severe) and 2.3{\%}, hoarseness (recurrent laryngeal nerve (RLN) injury, temporary/permanent). Logistic regression analysis identified an association between hypocalcemia and RLN injury with age, hospital category, surgical procedure types (total thyroidectomy, unilateral, bilateral subtotal or total resection). A lower incidence of hypocalcemia was related to preoperative neck ultrasound and FNAC analysis (the odds ratio (OR)=0.5 and 0.65, [95{\%} confidence interval (CI) 0.331-0.768 and 0.459-0.911], P=0.0014 and 0.0127, respectively), while RLN injury was not associated with any preoperative evaluation. The ORs of hypocalcemia and RLN injury for patients older than 50 years were 0.55 and 2.15, [0.393-0.763 and 1.356-3.4], P<0.001 and 0.0012, respectively. Conclusions: The success of thyroid surgery depends on careful preoperative planning, including a preoperative neck ultrasound to determine the proximity of the nodule to the recurrent laryngeal nerve course, and the consideration of the type of anesthesia, adjuvant devices for intra-op monitoring of the RLN, and surgical modalities. Our results suggest that preoperative evaluation implementations are positively associated with strategy of surgery and postoperative hypocalcemia prevention. •Thyroid surgery depends on careful preoperative planning.•Evaluation for lesions, adjuvant devices, and surgical modalities are important.•Preoperative evaluation affects the hypocalcemia.•Intraoperative monitor may reduce RLN injury.",
author = "Huang, {Chien Feng} and Yachung Jeng and Chen, {Kuo Dong} and Yu, {Ji Kuen} and Shih, {Chao Ming} and Shih-Ming Huang and Lee, {Chen Hsen} and Chou, {Fong Fu} and Shih, {Ming Lang} and Jeng, {Kee Ching} and Chang, {Tzu Ming}",
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Huang, CF, Jeng, Y, Chen, KD, Yu, JK, Shih, CM, Huang, S-M, Lee, CH, Chou, FF, Shih, ML, Jeng, KC & Chang, TM 2015, 'The preoperative evaluation prevent the postoperative complications of thyroidectomy', Annals of Medicine and Surgery, vol. 4, no. 1, pp. 5-10. https://doi.org/10.1016/j.amsu.2014.11.005

The preoperative evaluation prevent the postoperative complications of thyroidectomy. / Huang, Chien Feng; Jeng, Yachung; Chen, Kuo Dong; Yu, Ji Kuen; Shih, Chao Ming; Huang, Shih-Ming; Lee, Chen Hsen; Chou, Fong Fu; Shih, Ming Lang; Jeng, Kee Ching; Chang, Tzu Ming.

In: Annals of Medicine and Surgery, Vol. 4, No. 1, 01.03.2015, p. 5-10.

Research output: Contribution to journalArticle

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T1 - The preoperative evaluation prevent the postoperative complications of thyroidectomy

AU - Huang, Chien Feng

AU - Jeng, Yachung

AU - Chen, Kuo Dong

AU - Yu, Ji Kuen

AU - Shih, Chao Ming

AU - Huang, Shih-Ming

AU - Lee, Chen Hsen

AU - Chou, Fong Fu

AU - Shih, Ming Lang

AU - Jeng, Kee Ching

AU - Chang, Tzu Ming

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Thyroid surgery is generally a safe surgery but its complications are still common. We wish to identify preoperative factors that predict postoperative complications. Methods: A nationwide survey was conducted by senior surgeons from 16 medical centers and 5 regional hospitals in Taiwan to thyroid operations performed over 3 years. 3846 cases were retrospectively examined to identify factors influencing complications: indication for surgery, preoperative evaluation, such as ultrasonography, chest X-ray, computed tomography and magnetic resonance imaging, isotope scanning, fine-needle aspiration cytology (FNAC) and thyroid function test, and patient characteristics. Results: Eighty-four percent of patients were female. Seven percent of the patients had immediate postoperative hypocalcemia (mild and severe) and 2.3%, hoarseness (recurrent laryngeal nerve (RLN) injury, temporary/permanent). Logistic regression analysis identified an association between hypocalcemia and RLN injury with age, hospital category, surgical procedure types (total thyroidectomy, unilateral, bilateral subtotal or total resection). A lower incidence of hypocalcemia was related to preoperative neck ultrasound and FNAC analysis (the odds ratio (OR)=0.5 and 0.65, [95% confidence interval (CI) 0.331-0.768 and 0.459-0.911], P=0.0014 and 0.0127, respectively), while RLN injury was not associated with any preoperative evaluation. The ORs of hypocalcemia and RLN injury for patients older than 50 years were 0.55 and 2.15, [0.393-0.763 and 1.356-3.4], P<0.001 and 0.0012, respectively. Conclusions: The success of thyroid surgery depends on careful preoperative planning, including a preoperative neck ultrasound to determine the proximity of the nodule to the recurrent laryngeal nerve course, and the consideration of the type of anesthesia, adjuvant devices for intra-op monitoring of the RLN, and surgical modalities. Our results suggest that preoperative evaluation implementations are positively associated with strategy of surgery and postoperative hypocalcemia prevention. •Thyroid surgery depends on careful preoperative planning.•Evaluation for lesions, adjuvant devices, and surgical modalities are important.•Preoperative evaluation affects the hypocalcemia.•Intraoperative monitor may reduce RLN injury.

AB - Thyroid surgery is generally a safe surgery but its complications are still common. We wish to identify preoperative factors that predict postoperative complications. Methods: A nationwide survey was conducted by senior surgeons from 16 medical centers and 5 regional hospitals in Taiwan to thyroid operations performed over 3 years. 3846 cases were retrospectively examined to identify factors influencing complications: indication for surgery, preoperative evaluation, such as ultrasonography, chest X-ray, computed tomography and magnetic resonance imaging, isotope scanning, fine-needle aspiration cytology (FNAC) and thyroid function test, and patient characteristics. Results: Eighty-four percent of patients were female. Seven percent of the patients had immediate postoperative hypocalcemia (mild and severe) and 2.3%, hoarseness (recurrent laryngeal nerve (RLN) injury, temporary/permanent). Logistic regression analysis identified an association between hypocalcemia and RLN injury with age, hospital category, surgical procedure types (total thyroidectomy, unilateral, bilateral subtotal or total resection). A lower incidence of hypocalcemia was related to preoperative neck ultrasound and FNAC analysis (the odds ratio (OR)=0.5 and 0.65, [95% confidence interval (CI) 0.331-0.768 and 0.459-0.911], P=0.0014 and 0.0127, respectively), while RLN injury was not associated with any preoperative evaluation. The ORs of hypocalcemia and RLN injury for patients older than 50 years were 0.55 and 2.15, [0.393-0.763 and 1.356-3.4], P<0.001 and 0.0012, respectively. Conclusions: The success of thyroid surgery depends on careful preoperative planning, including a preoperative neck ultrasound to determine the proximity of the nodule to the recurrent laryngeal nerve course, and the consideration of the type of anesthesia, adjuvant devices for intra-op monitoring of the RLN, and surgical modalities. Our results suggest that preoperative evaluation implementations are positively associated with strategy of surgery and postoperative hypocalcemia prevention. •Thyroid surgery depends on careful preoperative planning.•Evaluation for lesions, adjuvant devices, and surgical modalities are important.•Preoperative evaluation affects the hypocalcemia.•Intraoperative monitor may reduce RLN injury.

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