Recurrent Laryngeal Nerve Injury After Thyroid Surgery at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia

Background: Recurrent laryngeal nerve (RLN) injury, a dreaded complication in thyroid surgery, remains a concern even in the hands of seasoned surgeons. It stands as a significant cause for medical malpractice claims against surgeons. Objective: To assess the Magnitude of RLN injury and associated factors in patients undergoing thyroid surgery at St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia, from May 1st, 2021, to April 30^th, 2022. Methods: A facility-based, observational study was conducted at SPHMMC, Addis Ababa, Ethiopia. Data was collected using a structured questionnaire designed with Google Forms. A census sampling approach was used to select the data charts to ensure a comprehensive perspective. This method ensured a representative sample of the population under study, enhancing the reliability of the results. The information was transferred to Excel and then imported into SPSS. Descriptive statistics were employed to summarize the key characteristics within the dataset concisely. Stepwise multiple logistic regression was implemented to explore the potential relationships between the independent and dependent variables. A significance level of p < 0.05 was adopted to identify statistically meaningful results. The findings are presented through a combination of text, tables, and figures. Results: The study included a total of 185 patients, with a mean± SD age of 41.62 ± 12.72 and a median age of 40. Females constituted 78.9% of the participants. The study's key finding is a persistent RLN injury rate of 5.4% (10/185). After adjusting for other covariates, the odds of developing persistent RLN injury were found to be 30 times higher among patients who had central neck dissection than those who had not undergone central neck dissection (AOR=30.0, 95%CI=4.3,211.9, p-value=0.001). However, sex, substernal goiter, histologic finding, preoperative toxicity, extent of thyroidectomy, and identification of RLN intra-operatively were not associated with persistent RLN injury in bivariate logistic regression analysis. Conclusion: This study found a persistent, recurrent laryngeal nerve injury rate of 5.4% in patients undergoing thyroid surgery. Central neck dissection was the only factor significantly associated with an increased risk of recurrent laryngeal nerve injury. These findings suggest minimizing central neck dissection when feasible during thyroid surgery to reduce the risk of this complication.