Predictive Value of the Estimation of Physiologic Ability and Surgical Stress for Postoperative Recurrent Laryngeal Nerve Injury in Patients With Type 2 Diabetes Mellitus Complicated by Thyroid Cancer: A Retrospective Cohort Study.

Aims/Background In the postoperative management of patients with type 2 diabetes mellitus (T2DM) and thyroid cancer, recurrent laryngeal nerve (RLN) injury is a significant complication. Due to existing metabolic abnormalities, surgical stress may further impair the recovery of physiological functions in these patients. This study aimed to investigate the predictive value of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) system for postoperative RLN injury in patients with T2DM complicated by thyroid cancer. Methods A retrospective analysis was conducted on 210 patients with T2DM complicated by thyroid cancer who were admitted to Xinzheng Huaxin Minsheng Hospital from January 2021 to December 2023. Clinical data were collected from the electronic medical record system. Patients were divided into the injury group (n = 60) and the non-injury group (n = 150) based on the occurrence of postoperative RLN injury. Univariate and multivariate logistic regression analyses were performed to identify factors associated with RLN injury. The predictive value of E-PASS for postoperative RLN injury was evaluated using receiver operating characteristic (ROC) curve analysis. Results Univariate and multivariate logistic regression analyses revealed that preoperative risk score (PRS), surgical stress score (SSS), and comprehensive risk score (CRS) were independent risk factors for RLN injury in patients with T2DM and thyroid cancer (p < 0.05). ROC curve analysis indicated that the area under the curve (AUC) for E-PASS was 0.866, with a standard error of 0.026 (95% CI: 0.814-0.917). The optimal cutoff value was 0.70, yielding a sensitivity of 91.54% and a specificity of 62.55%. Conclusion The comprehensive risk assessment provided by E-PASS demonstrates good predictive value for RLN injury in patients with T2DM complicated by thyroid cancer. Integrating PRS, SSS, and CRS can enhance risk assessment and guide early intervention to promote postoperative recovery.