良性、无毒甲状腺肿手术处理程度的相关风险

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology Pub Date : 2025-07-26 DOI:10.1002/lio2.70214

Jacob S. Brady, Neeraja Konuthula, Austin Lam, Sean Massa, Zain H. Rizvi

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引用次数: 0

摘要

目的：良性、无毒甲状腺肿的手术仍然是世界范围内甲状腺切除术最常见的指征，但最佳手术范围仍存在争议。虽然全甲状腺切除术被认为比肺叶切除术风险更大，但其并发症的差异尚未被量化。本研究的目的是：(1)比较手术并发症的风险；(2)量化这种风险差异的程度。方法：采用2016-2020年国家外科质量改进计划（NSQIP）甲状腺特异性数据集与一般NSQIP数据集协调的回顾性分析。本研究旨在通过控制混杂因素的多变量分析，确定与甲状腺小叶切除术相比，甲状腺全切除术是否与术后并发症独立相关。暴露组为肺叶切除术（CPT 60220）和甲状腺全切除术（CPT 60240）。结果包括总并发症、甲状腺切除术特异性并发症（出院前低钙、出院30天内低钙、临床严重低钙、喉返神经功能障碍、颈部血肿）、其他手术并发症（感染、伤口破裂、输血）、内科并发症、计划外再入院、再手术、住院时间和手术时间。结果共行甲状腺切除术88929例，其中肺叶切除术5052例，全甲状腺切除术3877例。全甲状腺切除术与任何并发症（OR = 1.8, CI = 1.5 - 2.2）、任何甲状腺切除术特异性并发症（OR = 1.9, CI = 1.6-2.3）、RLN功能障碍（OR = 1.5, CI = 1.2-1.9）、出院前低钙血症（OR = 3.8, CI = 2.2-6.7）、出院后低钙血症（OR = 4.6, CI = 3.1-6.8）和严重低钙血症（OR = 5.4, CI = 3.2-9.0）的发生率显著升高相关。非计划再入院率（OR = 1.5, CI = 1.1-2.3）、住院时间（+ 0.33天，CI = 0.1-0.5）和手术时间（+ 26.1 min）。CI = 23.7-28.6)，全甲状腺切除术后甲状腺功能指数也有所上升。在这项迄今为止规模最大的研究中，在控制合并症、疾病范围和钙补充的情况下，全甲状腺切除术患者的手术和药物并发症以及再入院率明显更高。这些数据应该为共同决策提供参考，以确定该疾病的手术干预程度。证据级别4。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Risks Associated With Extent of Surgical Management for Benign, Non-Toxic Goiter

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Risks Associated With Extent of Surgical Management for Benign, Non-Toxic Goiter

Objectives

Surgery for benign, non-toxic thyroid goiter remains the most common indication for thyroidectomy worldwide, yet the optimal surgical extent remains controversial. While total thyroidectomy is assumed to have greater risks than lobectomy, the difference in complications has not been quantified. The objectives of this study are to (1) compare the risk of surgical complications and (2) quantify the magnitude of this risk difference.

Methods

This is a retrospective analysis utilizing the National Surgical Quality Improvement Program (NSQIP) Thyroid-Specific Dataset harmonized with the general NSQIP dataset for the years 2016–2020. The study was designed to determine if total thyroidectomy is independently associated with postoperative complications when compared to thyroid lobectomy using multivariable analyses controlling for confounding factors. Exposure groups were lobectomy (CPT 60220) and total thyroidectomy (CPT 60240). Outcomes included overall complications, thyroidectomy-specific complications (hypocalcemia prior to discharge, hypocalcemia within 30 days of discharge, clinically severe hypocalcemia, recurrent laryngeal nerve dysfunction, neck hematoma), other surgical complications (infections, wound disruption, and blood transfusion), medical complications, unplanned readmission, reoperation, length of stay, and operative time.

Results

Eight thousand nine hundred twenty-nine thyroidectomies were included: 5052 lobectomies and 3877 total thyroidectomies. Total thyroidectomy was associated with significantly greater odds of any complication (OR = 1.8, CI = 1.5–2.2), any thyroidectomy-specific complication (OR = 1.9, CI = 1.6–2.3), increased odds of RLN dysfunction (OR = 1.5, CI = 1.2–1.9), hypocalcemia prior to discharge (OR = 3.8, CI = 2.2–6.7), hypocalcemia after discharge (OR = 4.6, CI = 3.1–6.8), and severe hypocalcemia (OR = 5.4, CI = 3.2–9.0). Rates of unplanned readmission (OR = 1.5, CI = 1.1–2.3), length of hospital stay (+ 0.33 days, CI = 0.1–0.5), and operative time (+ 26.1 min. CI = 23.7–28.6) were also increased in total thyroidectomy.

Conclusions

In this largest study to date, when controlling for comorbidity, extent of disease, and calcium repletion, total thyroidectomy patients had significantly greater rates of surgical and medical complications, as well as readmission. These data should inform shared decision making when determining extent of surgical intervention for this disease.