Multivariate Analysis of Risk Factors for Postoperative Complications in Benign Goiter Surgery: Prospective Multicenter Study in Germany
Abstract
Risk factors for postoperative complications of benign goiter surgery have not been investigated systematically. To this end, a prospective multicenter study (January 1 through December 31, 1998) was conducted involving 7266 patients with surgery for benign goiter from 45 East German hospitals. High‐volume providers (>150 operations per year) performed 69% (5042/7266), intermediate‐volume providers 27% (50–150), and low‐volume providers 4% (258/7266) of operations. Among the hospital groups, the pattern of thyroid disease did not vary significantly, but there was a trend that small‐volume providers tended to perform more operations for uninodular goiter and high‐volume providers treated more patients with Graves' disease and recurrent goiter. Extent of resection (p < 0.0001) and remnant size (multinodular goiter and recurrent goiter, p < 0.001), differed significantly, with total thyroidectomy being performed more often in hospitals with more than 150 operations compared to hospitals with an operative volume of less than 150 procedures per year. Despite the larger extent of resection and smaller remnant size, rates of recurrent laryngeal nerve (RLN) palsy or hypoparathyroidism were not increased. When the logistic regression analyses were fitted to evaluate the impact of risk factors on transient and permanent RLN palsy and hypoparathyroidism, larger extent of resection [relative risk (RR) 1.5–2.1] and recurrent goiter (RR 1.8–3.4) consistently evolved as independent risk factors. With hypoparathyroidism, additional significant factors included patient gender (RR 2.1–2.4), hospital operative volume (RR 0.8–1.5), and Graves' disease (RR 2.8). Unlike parathyroid gland identification during hypoparathyroidism, RLN identification (RR 1.6) significantly (p= 0.01) reduced permanent RLN palsy rates. The multivariate analyses clearly confirmed the pivotal role of routine RLN identification, independent of the extent of the thyroid resection. These findings might help hospitals with lower operative volumes to identify patients at increased risk whom they might consider for specialist care.
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Remedial thyroid surgery comes at significantly increased risk of hypoparathyroidism and RLN injury.
“As remedial thyroid surgery comes at significantly increased risk of hypoparathyroidism and RLN injury, it should be avoided, if possible, in favor of RAI therapy (290,291).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [291]
Reoperation for recurrent or persistent goiter results in a 3- to 10-fold increase in the risk of permanent vocal cord paralysis or hypoparathyroidism.
“Reoperation for recurrent or persistent goiter results in a 3-to 10-fold increase in the risk of permanent vocal cord paralysis or hypoparathyroidism (290,291).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [291]
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Genser, L., Trésallet, C., Godiris-Petit, G., Li Sun Fui, S., Salepcioglu, H., Royer, C., & Menegaux, F. (2014) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2013.05.007 · Cited by 47 · see citing works
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- Authors
- Thomusch, O., Machens, A., Sekulla, C., Ukkat, J., Lippert, H., Gastinger, I., & Dralle, H.
- Affiliations
- Martin Luther University Halle-Wittenberg (DE)
- Otto-von-Guericke-Universität Magdeburg (DE)
- Medizinische Universität Lausitz - Carl Thiem (DE)
- Venue
- World Journal of Surgery
- Publisher
- Wiley
- Published
- 2000-11
- Volume
- 24
- Issue
- 11
- Pages
- 1335-1341
- ISSN
- 0364-2313 (ISSN-L)
- 1432-2323
- OpenAlex
- W2013116900
- Cited by
- 551
- References
- 20
- Citations by year
- 2026: 15 · 2025: 8 · 2024: 18 · 2023: 28 · 2022: 28 · 2021: 22 · 2020: 28 · 2019: 23 · 2018: 28 · 2017: 21 · 2016: 28 · 2015: 29 · 2014: 31 · 2013: 26 · 2012: 20
- FWCI
- 7.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- World Journal of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Svenska Forskningsrådet Formas
- Topics
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Keywords
- postoperative complications, recurrent laryngeal nerve palsy, hypoparathyroidism, thyroidectomy, extent of thyroid surgery, recurrent goiter, Graves' disease, multinodular goiter, risk factors
- MeSH terms
- Adult, Aged, Female, Follow-Up Studies, Germany, Goiter, Humans, Hypoparathyroidism, Male, Middle Aged, Organ Size, Postoperative Complications, Prospective Studies, Risk Factors, Thyroid Gland, Thyroidectomy, Vocal Cord Paralysis, Incidence, Multivariate Analysis, Logistic Models, Age Distribution, Sex Distribution
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