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Qian L, Tang J, Jiang F, Sun S, Zhang S, Yue X, Yao T. The impact of body mass index on operative time in transoral endoscopic thyroidectomy vestibular approach for thyroid cancer. Endocrine 2024; 84:179-184. [PMID: 38091199 DOI: 10.1007/s12020-023-03616-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/13/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND The impact of body mass index (BMI) on operative time in transoral endoscopic thyroidectomy vestibular approach (TOETVA) for thyroid cancer is still a subject of debate. This study assessed the impact of BMI on operative time and postoperative complications in patients undergoing TOETVA. METHODS The study has been conducted to compare the outcomes of TOETVA in patients with high BMI (≥25) and those with normal BMI (<25). Postoperative outcomes, including operative time, blood lost, recurrent laryngeal nerve (RLN) palsy, hypocalcemia and postoperative pain score, were evaluated. RESULTS A total of 62 patients who underwent TOETVA were included in the study. The high BMI group consisted of 39 patients, while the normal BMI group included 23 patients. No significant differences were observed between the two groups regarding operative time, blood loss, postoperative pain score, and postoperative complications such as recurrent laryngeal nerve (RLN) palsy and hypocalcemia. CONCLUSIONS BMI was not significantly associated with operative time and postoperative complications in patients undergoing TOETVA, indicating its safety and feasibility for elevated BMI patients.
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Affiliation(s)
- Liyu Qian
- Department of Surgical Oncology, The First Affiliated of Bengbu Medical College, Bengbu, China
| | - Jie Tang
- Department of Surgical Oncology, The First Affiliated of Bengbu Medical College, Bengbu, China
| | - Fangqian Jiang
- Department of Surgical Oncology, The First Affiliated of Bengbu Medical College, Bengbu, China
| | - Siyu Sun
- Department of Surgical Oncology, The First Affiliated of Bengbu Medical College, Bengbu, China
| | - Song Zhang
- Department of Surgical Oncology, The First Affiliated of Bengbu Medical College, Bengbu, China
| | - Xicheng Yue
- Department of Surgical Oncology, The First Affiliated of Bengbu Medical College, Bengbu, China
| | - Tingjing Yao
- Department of Surgical Oncology, The First Affiliated of Bengbu Medical College, Bengbu, China.
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Armstrong VL, Funkhouser A, Memeh K, Heidel E, Mancini M, Vaghaiwalla T. Thyroidectomy Outcomes in Obese Patients. J Surg Res 2024; 295:717-722. [PMID: 38142574 DOI: 10.1016/j.jss.2023.11.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Obese patients often have higher complication rates after elective general surgeries; however, few studies have examined the outcomes after thyroidectomy. This study examines whether increased body mass index (BMI) is associated with poor postoperative outcomes after thyroid surgery. METHODS A retrospective review of patients who underwent thyroidectomy from 2015 to 2018 was performed. Demographics, comorbidities, pathology, and extent of resection (total versus hemithyroidectomy) were examined. Patients were classified into BMI groups according to the WHO definitions, and the incidence of surgical outcomes was determined in each group. Surgical outcomes of interest included readmission rates (RRs), length of stay, average operating room time, return to the operating room, hypocalcemia, postop infections, hematomas, and recurrent laryngeal nerve injury. Between-subjects statistics including independent samples t-test, ANOVA, and chi-square analyses were performed. RESULTS There were n = 465 patients included with a mean BMI 32.35 (standard deviation = 8.55) and median BMI 30.78 (Q1 = 26.26, Q3 = 36.73). There were no differences between BMI groups in age, gender, smoking, heart disease. There was a positive association between increased BMI and postoperative infection (P < 0.001), pneumonia (P = 0.018), and surgical site infection (P = 0.04), which were highest for BMI > 40. Increased BMI was associated with a higher 30-d RR (P = 0.008), particularly for BMI >40 versus BMI <40 (6.2% versus 1.05%; P = 0.003). There were no significant differences between surgical outcomes for patients with increased BMI who underwent total thyroidectomy or hemithyroidectomy. CONCLUSIONS Excellent postoperative outcomes were observed in all BMI categories. Higher postoperative infection and 30-d RRs were observed in the morbidly obese. Contrary to previous studies, operating room times were similar regardless of BMI.
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Affiliation(s)
| | - Alex Funkhouser
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
| | - Kelvin Memeh
- Department of Surgery, Methodist University Hospital, Memphis, Tennessee
| | - Eric Heidel
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
| | - Matt Mancini
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
| | - Tanaz Vaghaiwalla
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
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Karakawa R, Konishi T, Yoshimatsu H, Hashimoto Y, Matsui H, Fushimi K, Yano T, Yasunaga H. Association between body mass index and outcomes after autologous breast reconstruction: a nationwide inpatient database study in Japan. Breast Cancer Res Treat 2024; 204:69-78. [PMID: 37966699 DOI: 10.1007/s10549-023-07162-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/07/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Although autologous reconstruction following breast cancer surgery is common, little is known about the association between preoperative body mass index (BMI) and short-term surgical outcomes. This study investigated the association between BMI and short-term surgical outcomes in autologous breast reconstruction using a nationwide Japanese inpatient database. METHODS We retrospectively identified female patients with breast cancer who underwent breast reconstruction using a pedicled flap or free flap from July 2010 to March 2020. Multivariable regression analyses and restricted cubic spline analyses were conducted to investigate the associations between BMI and short-term outcomes with adjustment for demographic and clinical backgrounds. RESULTS Of the 13,734 eligible patients, 7.1% and 22.2% had a BMI of < 18.5 kg/m2 and > 25 kg/m2, respectively. Compared with BMI of 18.5-21.9 kg/m2, overweight (25.0-29.9 kg/m2) and obese (≥ 30.0 kg/m2) were significantly associated with higher occurrences of takebacks (odds ratio, 1.74 [95% confidence interval, 1.28-2.38] and 2.89 [1.88-4.43], respectively) and overall complications (1.37 [1.20-1.57] and 1.77 [1.42-2.20], respectively). In the restricted cubic spline analyses, BMI showed J-shaped associations with takebacks, overall complications, local complications, and wound dehiscence. BMI also demonstrated linear associations with postoperative surgical site infection, duration of anesthesia, duration of drainage, length of stay, and hospitalization costs. CONCLUSION In autologous breast reconstruction following breast cancer surgery, a higher BMI was associated with takebacks, morbidity, a longer hospital stay, and higher total costs, whereas a lower BMI was associated with fewer surgical site infections, a shorter hospital stay, and lower total costs.
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Affiliation(s)
- Ryo Karakawa
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, Japan.
| | - Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hidehiko Yoshimatsu
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, Japan
| | - Yohei Hashimoto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Tomoyuki Yano
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-Ku, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Rossi L, Becucci C, Iachini M, Ambrosini CE, Renieri F, Morganti R, Pignatelli F, Materazzi G. The impact of obesity on thyroidectomy outcomes: a case-matched study. Updates Surg 2024; 76:219-225. [PMID: 37989908 PMCID: PMC10806022 DOI: 10.1007/s13304-023-01687-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023]
Abstract
Obesity is a well-known public health concern in Western World. Accordingly, an elevated number of obese patients undergo thyroidectomy every year. We aim to assess the impact of obesity on intraoperative and postoperative outcomes of patients who undergo thyroidectomy. 1228 patients underwent thyroidectomy at our department between January 2021 and September 2021. We divided patients into two groups according to body mass index (BMI): non-obese (BMI < 30 kg/m2) and obese (BMI ≥ 30 kg/m2). A propensity score approach was performed to create 1:1 matched pairs (matching according to age, gender, diagnosis, nodule size and type of operation). After matching, the final population included 522 patients, equally divided between each group: non-obese group (Group A; n = 261) and obese group (Group B; n = 261). The primary endpoint of the study was the overall rate of postoperative complications; secondary endpoints of the study were operative time, use of energy device and length of hospital stay. The duration of hospital stay resulted longer in Group B (p = 0.002). No statistically significant differences were documented in terms of operative time (p = 0.206), use of energy devices (p = 0.855) and surgical complications (p = 0.429). Moreover, no statistically significant differences were documented considering each specific complication: transient and permanent hypocalcemia (p = 0.336; p = 0.813, respectively), transient and permanent recurrent laryngeal nerve palsy (p = 0.483; p = 0.523, respectively), hematoma (p = 0.779), bleeding (p = 0.178), wound infection (p = 0.313) and cheloid formation (p = 0.412). Thyroidectomy can safely be performed in obese patients. Outcomes resulted comparable; nonetheless, obesity correlates to longer hospital stay.
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Affiliation(s)
- Leonardo Rossi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy.
| | - Chiara Becucci
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Mattia Iachini
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Carlo Enrico Ambrosini
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Federica Renieri
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | | | - Francesco Pignatelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
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Kandil E, Issa PP, Randolph GW. Can Thyroid Nodules be Managed with Radiofrequency Ablation? Adv Surg 2023; 57:87-101. [PMID: 37536864 DOI: 10.1016/j.yasu.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Radiofrequency ablation (RFA) is an established and growing minimally-invasive technique with an impressive safety profile used to manage thyroid nodules. Beyond shorter operative and recovery times, the main advantages of RFA include the lack of an incisional scar as well as maximizing the potential for maintenance of normal thyroid function. RFA can significantly reduce nodular volume, achieving rates of 60% to 95% in a breadth of thyroid disease, including benign nodules, primary carcinomas, and recurrent malignancies. Thorough patient counselling is imperative for RFA candidates, including a discussant of complications, nodule regrowth, and the potential for a subsequent ablation session.
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Affiliation(s)
- Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Peter P Issa
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Gregory W Randolph
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
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Park Y, Yu HW, Lee JK, Choi JH, Kim W, Kwak J, Kim SJ, Chai YJ, Suh H, Choi JY, Lee KE. Effect of body habitus on surgical outcomes following bilateral axillo-breast approach robotic thyroidectomy: a retrospective cohort study. Int J Surg 2023; 109:1257-1263. [PMID: 36999794 PMCID: PMC10389347 DOI: 10.1097/js9.0000000000000279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/10/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION BMI has been shown to predict perioperative outcomes in patients undergoing surgery. Most studies assessing the role of body habitus in thyroid surgery have focused on open surgery, with few studies assessing patients undergoing robotic surgery. The present study evaluated the effects of BMI on surgical outcomes in patients undergoing bilateral axillo-breast approach (BABA) robotic thyroidectomy. MATERIALS AND METHODS This study included patients who underwent BABA robotic thyroidectomy between January 2013 and September 2021 at Seoul National University Bundang Hospital. Patients were categorized into six groups based on the WHO classification of overweight and obesity. Clinicopathological characteristics, postoperative complications, and surgical outcomes were evaluated. RESULTS A total of 1921 patients were included. Comparisons of the six BMI groups showed no statistically significant differences in postoperative stay, resection margin involvement, postoperative complications, and recurrence. Subgroup analysis showed that hypocalcemia rates differed among BMI groups in patients who underwent lobectomy, with underweight and class II obese patients being at the highest risk ( P =0.006). However, the actual number of complications was relatively small and similar among the groups. In patients who underwent total thyroidectomy and isthmectomy, BMI was not correlated with postoperative complications, including hypocalcemia, recurrent laryngeal nerve palsy, postoperative bleeding, and chyle leakage. CONCLUSION Body habitus was not significantly associated with operative time and postoperative complications in patients undergoing BABA robotic thyroidectomy, indicating that this approach is safe and feasible in obese patients.
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Affiliation(s)
- Yeshong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
- Department of Surgery, Seoul National University College of Medicine
| | - Ja Kyung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - Jee-Hye Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
- Department of Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Woochul Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
| | - JungHak Kwak
- Department of Surgery, Seoul National University Hospital, Jongno-gu
| | - Su-jin Kim
- Department of Surgery, Seoul National University College of Medicine
- Department of Surgery, Seoul National University Hospital, Jongno-gu
| | - Young Jun Chai
- Department of Surgery, Seoul National University College of Medicine
- Department of Surgery, Seoul National University Boramae Medical Center, Dongjak-gu, Seoul, Korea
| | - Hyunsuk Suh
- Suh Scarless Thyroid Surgery Center, Tampa, Florida, USA
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do
- Department of Surgery, Seoul National University College of Medicine
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University College of Medicine
- Department of Surgery, Seoul National University Hospital, Jongno-gu
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Dong M, Song JL, Hu LL, Hong CC, Nie XY, Wang Z, Liao SC, Yao F. Analysis of preoperative influential factors and construction of a predictive nomogram of difficult thyroidectomy. BMC Surg 2023; 23:91. [PMID: 37069574 PMCID: PMC10111741 DOI: 10.1186/s12893-023-01990-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/04/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVE To explore the preoperative influential factors of difficult thyroidectomy and establish a preoperative nomogram for predicting the difficulty of thyroidectomy. METHODS A total of 753 patients who underwent total thyroidectomy with central lymph node dissection between January 2018 and December 2021 were retrospectively enrolled in this study and randomly divided into training and validation groups at a ratio of 8:2. In both subgroups, the patients were divided into difficult thyroidectomy and nondifficult thyroidectomy groups based on the operation time. Patient age, sex, body mass index (BMI), thyroid ultrasound, thyroid function, preoperative fine needle aspiration (FNA), postoperative complications and other data were collected. Logistic regression analysis was performed to identify the predictors of difficult thyroidectomy, and a nomogram predicting surgical difficulty was created. RESULTS Multivariate logistic regression analysis demonstrated that male sex (OR = 2.138, 95% CI 1.055-4.336, p = 0.035), age (OR = 0.954, 95% CI 0.932-0.976, p < 0.001), BMI (OR = 1.233, 95% CI 1.106-1.375, p < 0.001), thyroid volume (OR = 1.177, 95% CI 1.104-1.254, p < 0.001) and TPO-Ab (OR = 1.001, 95% CI 1.001-1.002, p = 0.001) were independent risk factors for difficult thyroidectomy. The nomogram model incorporating the above predictors performed well in both the training and validation sets. A higher postoperative complication rate was found in the difficult thyroidectomy group than in the nondifficult thyroidectomy group. CONCLUSION This study identified independent risk factors for difficult thyroidectomy and created a predictive nomogram for difficult thyroidectomy. This nomogram may help to objectively and individually predict surgical difficulty before surgery and provide optimal treatment.
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Affiliation(s)
- Meng Dong
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jun-Long Song
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Lin-Lin Hu
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Chen-Chen Hong
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Xin-Yue Nie
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Zhong Wang
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
| | - Shi-Chong Liao
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
| | - Feng Yao
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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Mahvi DA, Witt RG, Lyu HG, Gawande AA, Nehs MA, Doherty GM, Cho NL. Increased BMI is Associated With Lower Risk of Hypocalcemia in Total Thyroidectomy Patients. J Surg Res 2022; 279:240-246. [DOI: 10.1016/j.jss.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 05/01/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
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Risk factors for difficult thyroidectomy and postoperative morbidity do not match: retrospective study from an endocrine surgery academic referral centre. Updates Surg 2022; 74:1943-1951. [PMID: 36063287 DOI: 10.1007/s13304-022-01371-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
Hyperthyroidism, goiter and thyroiditis have been associated with complex thyroidectomy. Difficult thyroidectomies may implicate longer operating times and higher complication rates, while literature on quantification and prediction of difficulty in thyroidectomy is scant. We aim at assessing the impact of preoperative and intraoperative factors on the technical difficulty of total thyroidectomy (TT) and on the incidence of postoperative complications. We conducted a retrospective study on 197 TT from 343 thyroidectomies performed with intraoperative neuromonitoring between October 2019 and June 2022 (excluding lobectomies, nodal dissection, extra-thyroidal procedures). Operating time (surrogate of TT difficulty), postoperative hypocalcaemia, recurrent laryngeal nerve palsy and postoperative bleeding were assessed in relation to pre- and intraoperative characteristics. Vocal fold palsy(VFP) was defined as recovering < 12 months postoperatively. There were 87 thyroid cancers and 110 multinodular goiters (21 hyperfunctioning, 51 mediastinal). Median operating time was 136 min (range 51-310). Within 17.4 months overall median follow-up we recorded two transient VFPs and 12% symptomatic transient hypocalcaemia. At univariable analysis male sex (p = 0.005), BMI (p < 0.001), thyroiditis (p < 0.05), hypervascular goiter (p = 0.003) and thyroid adhesions to surrounding anatomical structures (p < 0.001) were associated with longer operating time. At multivariable analysis male male sex (p = 0.01), obesity (p = 0.001) and thyroid adhesions (p = 0.008) were factors for prolonged operating time. Above-normal anti-thyroid peroxidase antibodies correlated to transient symptomatic hypocalcemia (p < 0.001). Risk factors for complex TT were identified and did not correlate with morbidity rates. Results from this study may help optimizing operating room schedule and inform case selection criteria for training programs in thyroid surgery. Further research is required to confirm these findings.
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Konishi T, Fujiogi M, Michihata N, Niwa T, Morita K, Matsui H, Fushimi K, Tanabe M, Seto Y, Yasunaga H. Impact of body mass index on short-term outcomes after differentiated thyroid cancer surgery: a nationwide inpatient database study in Japan. Eur Thyroid J 2022; 11:ETJ-21-0081. [PMID: 34981742 PMCID: PMC9142812 DOI: 10.1530/etj-21-0081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/30/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Recent studies have shown worse post-operative outcomes following several surgeries in underweight or obese patients. However, the association between body mass index (BMI) and short-term outcomes following thyroid cancer surgery remains unclear because of the small number of patients, deficits in background data known as risk factors (e.g. cancer stage, operative procedure, intraoperative device use and hospital volume) and categorisation of BMI. METHODS We identified patients who underwent thyroidectomy for differentiated thyroid cancer from July 2010 to March 2017 using a Japanese nationwide inpatient database. We used restricted cubic spline (RCS) analyses to investigate potential non-linear associations between BMI (without categorisation) and outcomes: post-operative complications (local and general), duration of anaesthesia, post-operative length of hospital stay and hospitalisation costs. The analyses were adjusted for demographic and clinical backgrounds including the above-stated factors. We also performed multivariable regression analyses for the outcomes with categorisation of BMI. RESULTS Among 59,671 eligible patients, the median BMI was 22.9 kg/m2 (interquartile range (IQR), 20.7-25.6 kg/m2). In total, 3860 patients (6.5%) had local complications and 787 patients (1.3%) had general complications. Although there were no significant associations with local complications, such as bleeding, recurrent laryngeal nerve paralysis and surgical site infection, the occurrence of general complications was significantly associated with higher BMI. BMI showed a linear association with the duration of anaesthesia and U-shaped associations with post-operative length of stay and hospitalisation costs. The lowest points of the U-shaped curves occurred at a BMI of approximately 24 kg/m2. The multivariate regression analyses showed consistent results with the RCS analyses. DISCUSSION/CONCLUSION Whereas RCS analyses revealed no significant associations between BMI and post-operative local complications, obesity was significantly associated with the occurrence of general complications. The linear association between BMI and duration of anaesthesia corresponds to previous studies. Although post-operative length of stay and total hospitalisation costs demonstrated U-shaped associations, the slight differences would not be clinically important. Even if surgeons must pay attention to general complications in obese patients undergoing thyroid cancer surgery as well as other surgeries, underweight and overweight patients can undergo thyroidectomy as safely as patients with normal BMI.
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Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Correspondence should be addressed to T Konishi:
| | - Michimasa Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takayoshi Niwa
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Department of Health Services, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Williams-Karnesky RL, Krumeich L, Wachtel H, Fraker DL, Wirtalla C, Venuto FA, Sellers P, Kelz RR. Data to inform counseling on parathyroidectomy for secondary hyperparathyroidism of renal origin. Surgery 2022; 171:63-68. [PMID: 34497026 DOI: 10.1016/j.surg.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The risk of postoperative hungry bone syndrome after parathyroidectomy for secondary hyperparathyroidism of renal origin may alter the course of treatment, including the hospital length of stay and readmission rates. We sought to identify additional patient or hospital factors that might contribute to hungry bone syndrome after parathyroidectomy in patients with secondary hyperparathyroidism of renal origin. METHODS Patients who underwent a parathyroidectomy for secondary hyperparathyroidism of renal origin were identified in a geographically diverse, 10-state, discharge data set. Covariates included demographic data, payer status, 31 comorbidities, and hospital characteristics. The primary outcome variable of interest was hospital length of stay. Secondary outcomes were complications and 30-day readmission. RESULTS Of 796 patients studied, 164 patients (20.6%) were diagnosed with hungry bone syndrome. There were no differences in the rates of hungry bone syndrome by race or number of comorbidities. The average age of hungry bone syndrome patients (45.7 years ± 13.9) was younger than that of non-hungry bone syndrome patients (50.7 ± 14.8; P < .001). Hungry bone syndrome was more common among obese patients than nonobese patients (25.0% vs 15.8%; P < .001). Parathyroid autotransplant was performed at similar rates in hungry bone syndrome and non-hungry bone syndrome patients (23.8% vs 23.1%; P = .821). Median length of stay was significantly longer for hungry bone syndrome patients (6 days, interquartile range: [4, 8] versus 3 days, interquartile range: [2-6]; P < .001). Similar 30-day readmission rates were observed (hungry bone syndrome: 41 (25%) versus non-hungry bone syndrome: 147 (23%); P = .640). CONCLUSION Hungry bone syndrome occurs in 1 of 5 patients after parathyroidectomy for secondary hyperparathyroidism of renal origin. Patients should be informed of the possibility of a relatively long (6 days) length of stay after surgery as well as the moderate possibility (>20%) of another hospitalization within the 30-day postdischarge period.
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Affiliation(s)
| | - Lauren Krumeich
- Department of Surgery, Division of Endocrine and Oncologic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Heather Wachtel
- Department of Surgery, Division of Endocrine and Oncologic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Douglas L Fraker
- Department of Surgery, Division of Endocrine and Oncologic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Chris Wirtalla
- Department of Surgery, Division of Endocrine and Oncologic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Frank Anthony Venuto
- Department of Surgery, Division of Endocrine and Oncologic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Pamela Sellers
- Department of Surgery, Division of Endocrine and Oncologic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Rachel R Kelz
- Department of Surgery, Division of Endocrine and Oncologic Surgery, University of Pennsylvania, Philadelphia, PA.
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Karakas E, Klein G, Michlmayr L, Schardey M, Schopf S. Transoral thyroid surgery vestibular approach: is there an increased risk of surgical site infections? Updates Surg 2021; 74:303-308. [PMID: 34671926 PMCID: PMC8827351 DOI: 10.1007/s13304-021-01191-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/07/2021] [Indexed: 11/28/2022]
Abstract
Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is an upcoming surgical technique with the aim to optimize cosmetic outcome avoiding visible scars in the neck. However, the transoral access bears the risk of contamination and microbial allocation from the mouth into the thyroid region. Therefore, some authors recommend extended antibiotic therapy up to 7 days after surgery. Our aim was to evaluate infection rates and parameters before and after transoral surgery and to suggest a viable and safe routine in transoral surgery. Prospectively collected data of patients who were eligible for transoral surgery in Austria and Germany between June 2017 and July 2020 were retrospectively evaluated focussing on clinical and laboratory infection signs pre and postoperatively. White blood cell count (WBC) and C-reactive protein levels (CRP) were estimated before and after surgery. Patients` characteristics, surgical outcome and complications were also determined and compared to the current results reported in the literature. 113 transoral operations were performed in 108 patients. In 37 of 108 (36%) patients an additional retroauricular incision in the hairline and in two patients a submental skin incision was performed to extract thyroid specimen of more than 40 ml. Intravenous antibiotic prophylaxis and enoral mucosal disinfection were used in all patients before surgery. WBC and CRP levels were available in 75 patients. Median WBC was 5800/µl (range 3500–10,500/µl) before and significantly higher (median 8900/µl, range 4500–18,800 µl; p < 0.01) at day one after surgery. WBC returned to normal range (4500–11,500/µl) in all patients within the first 7 days postoperatively (median 5300/µl, range 3400–8700/µl). CRP levels were normal before (< 0.5 mg/dl) and slightly elevated within the first two days after surgery (Median 2.0 mg/dl, range 0.5–6.4 mg/dl, n.s.). In one patient oral antibiotic therapy was necessary due to transient erythema in the chin region which occurred 10 days after surgery and resolved completely without surgical intervention. Despite a transient increase in WBC transoral thyroid and parathyroid surgery via the vestibular approach does not seem to be associated with a significant number of wound infections in our patients. Intravenous antibiotic prophylaxis and enoral mucosal disinfection might be reasonable procedures to avoid microbial allocation from the mouth into the thyroid region. However, further investigations are required to finally estimate the need of antibiotics in transoral surgery.
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Affiliation(s)
- Elias Karakas
- Department of General-, Abdominal- and Endocrine Surgery, Hospital Maria Hilf, Alexianer GmbH, 470805, Krefeld, Germany.
| | - Günther Klein
- Department of General Surgery, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Linda Michlmayr
- Department of General Surgery, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Martin Schardey
- Department of General-, Abdominal and Vascular Surgery, Hospital Agatharied, Hausham, Germany
| | - Stefan Schopf
- Department of General-, Abdominal- and Endocrine Surgery, RoMed Hospital, Bad Aibling, Germany
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Fanget F, Demarchi MS, Maillard L, El Boukili I, Gerard M, Decaussin M, Borson-Chazot F, Lifante JC. Hypoparathyroidism: Consequences, economic impact, and perspectives. A case series and systematic review. ANNALES D'ENDOCRINOLOGIE 2021; 82:572-581. [PMID: 34400129 DOI: 10.1016/j.ando.2021.07.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/23/2021] [Accepted: 07/12/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Postoperative hypoparathyroidism (PH) is the most common complication after total thyroidectomy. Incidence varies from 2% to 83%, depending on the definition. OBJECTIVE We performed a systematic review of the literature to determine the medico-economic effects of PH and update understanding of long-term consequences, morbidity, and quality of life related to hypoparathyroidism. METHODS We considered relevant articles published between 2000 and 2020 concerning long-term consequences of PH and quality of life. All studies concerning the medico-economic assessment of PH were included. We compared data from 2018 to results in the literature. RESULTS A proportion of 64/403 (16.8%) patients presented with transient PH during 2018, and 7/403 (1.7%) had permanent PH. Seven patients needed supplementation with alfacalcidol at 6-month follow-up. Factors predicting the need for alfacalcidol were age <45, thyroidectomy for goiter, and lymph node dissection. Additional therapy costs related to PH were €9781.10, and additional hospital costs were €230,400. We qualitatively synthesized 41 studies. Most were retrospective studies and only a few reported costs. No series assessed direct or indirect costs of postoperative PH. CONCLUSION To our knowledge, no previous studies reported the medico-economic impact of PH. Decreasing PH associated with fluorescence usage should be considered, particularly concerning cost-effectiveness.
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Affiliation(s)
- Florian Fanget
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France
| | - Marco Stefano Demarchi
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France; Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, 4, rue Gabrielle Perret-Gentil, 1211 Geneva, Switzerland
| | - Laure Maillard
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France
| | - Ilies El Boukili
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France
| | - Maxime Gerard
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France
| | - M Decaussin
- Department of Pathology, Hospices Civils de Lyon, Lyon, France
| | - Francoise Borson-Chazot
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France; Department of Pathology, Hospices Civils de Lyon, Lyon, France; Health Services and Performance Research Lab (EA 7425 HESPER), Université Claude-Bernard Lyon 1, Lyon, France; Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, 4, rue Gabrielle Perret-Gentil, 1211 Geneva, Switzerland
| | - Jean-Christophe Lifante
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France; Health Services and Performance Research Lab (EA 7425 HESPER), Université Claude-Bernard Lyon 1, Lyon, France.
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Kadoor AS, Patel K, Burton BN, Gabriel RA. Class 3 obesity is not associated with same-day admission in obese patients undergoing parathyroidectomy. J Clin Anesth 2021; 75:110472. [PMID: 34332495 DOI: 10.1016/j.jclinane.2021.110472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
IMPORTANCE Rising rates of obesity and outpatient performance of parathyroidectomies are making it increasingly crucial to investigate the association of obesity with post-operative complications. OBJECTIVE To determine whether Class 3 obesity is associated with increased same-day admission compared to lower obesity classes following outpatient parathyroidectomy. DESIGN Retrospective cohort study. SETTING Outpatient surgery. PATIENTS 12,973 patients ≥18 years old who underwent outpatient parathyroidectomy between 2014 and 2016, per the American College of Surgeons National Surgical Quality Improvement Program registry. INTERVENTIONS Primary exposure variable: body mass index (BMI), with patients assigned to one of six cohorts. MEASUREMENTS Primary outcome measure: same-day admission. Secondary outcome measure: 30-day readmission. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI). MAIN RESULTS There was a final sample size of 12,973 adult patients who underwent parathyroidectomy from 2014 to 2016. The admission rate for BMI ≥30 and < 40 kg/m2 (reference cohort) was 42.6%. The admission rates for Class 3 obesity categories were 46.2%, 56.2%, and 52.6% for those in the BMI range of ≥40 kg/m2 and < 50 kg/m2, ≥50 kg/m2 and < 60 kg/m2, and ≥ 60 kg/m2, respectively. On multivariable logistic regression, there were no difference in the odds of 30-day hospital admission or readmission rate with any of the BMI cohorts when compared to the reference group. CONCLUSIONS There is no significant difference in rates of same-day admission or 30-day readmission between any Class 3 (BMI ≥40 kg/m2) obesity cohort and the Class 1 and 2 (BMI ≥30 and < 40 kg/m2) reference cohort following outpatient parathyroidectomy. This corroborates the notion that BMI classes cannot be used in a vacuum to determine eligibility for outpatient parathyroidectomy - a concept that can guide safe and cost-effective institutional practices.
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Affiliation(s)
- Adarsh S Kadoor
- School of Medicine, University of California, San Diego (9500 Gilman Dr), La Jolla, CA 92093, USA).
| | - Kruti Patel
- Department of Anesthesiology, Division of Perioperative Informatics, University of California, San Diego (9500 Gilman Dr), La Jolla, CA 92093, USA.
| | - Brittany N Burton
- Department of Anesthesiology, University of California, Los Angeles (405 Hilgard Avenue), Los Angeles, CA 90095, USA.
| | - Rodney A Gabriel
- Department of Anesthesiology, Division of Perioperative Informatics, University of California, San Diego (9500 Gilman Dr), La Jolla, CA 92093, USA; Department of Medicine, Division of Biomedical Informatics, University of California, San Diego (9500 Gilman Dr), La Jolla, CA 92093, USA.
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15
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Morbid Obesity and Thyroid Cancer Rate. A Review of Literature. J Clin Med 2021; 10:jcm10091894. [PMID: 33925549 PMCID: PMC8123763 DOI: 10.3390/jcm10091894] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 02/08/2023] Open
Abstract
In the past three decades, several recent studies have analyzed the alarming increase of obesity worldwide, and it has been well established that the risk of many types of malignancies is increased in obese individuals; in the same period, thyroid cancer has become the fastest growing cancer of all malignancies. We investigated the current literature to underline the presence of a connection between excess body weight or Body Mass Index (BMI) and risk of thyroid cancer. Previous studies stated that the contraposition between adipocytes and adipose-resident immune cells enhances immune cell production of multiple pro-inflammatory factors with subsequent induction of hyperlipidemia and vascular injury; these factors are all associated with oxidative stress and cancer development and/or progression. Moreover, recent studies made clear the mitogenic and tumorigenic action of insulin, carried out through the stimulation of mitogen-activated protein kinase (MAPK) and phosphoinositide-3 kinase/AKT (PI3K/AKT) pathways, which is correlated to the hyperinsulinemia and hyperglycemia found in obese population. Our findings suggest that obesity and excess body weight are related to an increased risk of thyroid cancer and that the mechanisms that combine overweight with this cancer should be searched for in the adipokine pathways and chronic inflammation onset.
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Elsamna ST, Suri P, Mir GS, Roden DF, Paskhover B. Re: Metabolic syndrome and postoperative thyroidectomy outcomes. Head Neck 2021; 43:1973-1974. [PMID: 33634514 DOI: 10.1002/hed.26651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Samer T Elsamna
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Pooja Suri
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Ghayoour S Mir
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Dylan F Roden
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Boris Paskhover
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Celik SU, Konca C, Genc V. A Cohort Study Assessing the Association Between Body Composition Parameters and Symptomatic Hypocalcemia After Total Thyroidectomy. Am Surg 2020; 87:1305-1312. [PMID: 33345558 DOI: 10.1177/0003134820979578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postoperative hypocalcemia is one of the major concerns following thyroidectomy and the most frequent cause of prolonged hospital stay. The aim of this study was to evaluate the relationship between body composition parameters and symptomatic hypocalcemia following total thyroidectomy. In addition, the effects of disease- and patient-related factors on hypocalcemia were investigated. METHODS A total of 144 patients were prospectively included between March 2014 and September 2017. Patients were divided into 2 groups according to the presence or absence of clinical symptoms of hypocalcemia. Subsequently, the relationship between body composition parameters and hypocalcemia was evaluated. RESULTS Postoperative hypocalcemia-related symptoms occurred in 28 patients (19.4%). Permanent hypocalcemia was not encountered in any patient. Patients with hypocalcemic symptoms were more likely to have nodules ≥40 mm (39.3% vs. 17.2%, P = .011), retrosternal goiters (25.0% vs. 7.8%, P = .017), central lymph node dissection (LND) (32.1% vs. 11.2%, P = .015), and parathyroid autotransplantation (28.6% vs. 3.4%, P < .001) than those without symptoms. However, no differences were observed in the body composition parameters between symptomatic and asymptomatic patients. On multivariate analysis, lower preoperative intact parathyroid hormone (iPTH) levels (odds ratios (ORs) .96, 95% confidence intervals (CIs) .93-.99), the presence of retrosternal goiters (OR 10.26, 95% CI 2.23-47.14), central LND (OR 16.05, 95% CI 3.90-66.07), and parathyroid autotransplantation (OR 36.22, 95% CI 6.76-194.13) predicted hypocalcemia. DISCUSSION This study demonstrates that patients with lower preoperative iPTH levels, retrosternal goiters, central LND, and parathyroid autotransplantation are at an increased risk of developing clinical symptoms of hypocalcemia. Body composition parameters have no effect on the incidence of hypocalcemia after total thyroidectomy.
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Affiliation(s)
- Suleyman U Celik
- Department of General Surgery, 63990Ankara University School of Medicine, Turkey.,Department of General Surgery, Gulhane Training and Research Hospital, Turkey
| | - Can Konca
- Department of General Surgery, 63990Ankara University School of Medicine, Turkey
| | - Volkan Genc
- Department of General Surgery, 63990Ankara University School of Medicine, Turkey
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Risk Factors of Redo Surgery After Unilateral Focused Parathyroidectomy: Conclusions From a Comprehensive Nationwide Database of 13,247 Interventions Over 6 Years. Ann Surg 2020; 272:801-806. [PMID: 32833757 DOI: 10.1097/sla.0000000000004269] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Surgical removal of hyperfunctional parathyroid gland is the definitive treatment for primary hyperparathyroidism (pHPT). Postoperative follow-up shows variability in persistent/recurrent disease rate throughout different centers. OBJECTIVE To evaluate the incidence of redo surgery after targeted parathyroidectomy for pHPT. METHODS We performed a nationwide retrospective cohort study on the "Programme de Medicalisation des Systemes d'Information," the French administrative database that collects information on all healthcare facilities' discharges. We extracted data from 2009 to 2018 for all patients who underwent parathyroidectomy for pHPT between January 2011 to December 2016. The primary outcome was the reoperation rate within 2 years since first surgery. Patients who had a first attempt of surgery within the previous 24 months, familial hyperparathyroidism, multiglandular disease, and renal failure were excluded. Results were adjusted according to sex and the Elixhauser Comorbidity Index. Operative volume thresholds to define high-volume centers were achieved by the Chi-Squared Automatic Interaction Detector method. RESULTS In the study period, 13,247 patients (median age 63, F/M=3.6) had a focused parathyroidectomy by open (88.7%) or endoscopic approach. Need of remedial surgery was 2.8% at 2 years. In multivariate analysis, factors predicting redo surgery were: cardiac history (P=0.008), obesity (P=0.048), endoscopic approach (P=0.005), and low-volume center (P<0.001). We evaluated that an annual caseload of 31 parathyroidectomies was the best threshold to discriminate high-volume centers and carries the lowest morbidity/failure rate. CONCLUSION Although focused parathyroidectomy represents a standardized operation, cure rate is strongly associated with annual hospital caseload, type of procedure (endoscopic), and patients' features (obesity, cardiac history). Patients with risk factors for redo surgery should be considered for an open surgery in a high-volume center.
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Canu GL, Medas F, Cappellacci F, Podda MG, Romano G, Erdas E, Calò PG. Can thyroidectomy be considered safe in obese patients? A retrospective cohort study. BMC Surg 2020; 20:275. [PMID: 33160350 PMCID: PMC7648980 DOI: 10.1186/s12893-020-00939-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Obesity is a growing public health concern in most western countries. More and more patients with high body mass index (BMI) are undergoing surgical procedures of all kinds and, in this context, obese patients are undergoing thyroid surgery more than ever before. The aim of the present study was to evaluate whether thyroidectomy can be considered safe in obese patients. METHODS Patients undergoing thyroidectomy in our Unit between January 2014 and December 2018 were retrospectively analysed. Patients were divided into two groups: those with BMI < 30 kg/m2 were included in Group A, while those with BMI ≥ 30 kg/m2 in Group B. Univariate analysis was performed to compare these two groups. Moreover, multivariate analyses were performed to evaluate whether the BMI value (considered in this case as a continuous variable) had a significant role in the development of each individual postoperative complication. RESULTS A total of 813 patients were included in this study: 31 (3.81%) were underweight, 361 (44.40%) normal-weight, 286 (35.18%) overweight, 94 (11.57%) obese and 41 (5.04%) morbidly obese. Six hundred and seventy-eight patients were included in Group A and 135 in Group B. At univariate analysis, the comparison between the two groups, in terms of operative time and thyroid weight resulted in statistically significant results (P = 0.001, P = 0.008; respectively). These features were significantly higher in Group B than in Group A. About postoperative stay and complications, no statistically significant difference was found between the two groups. At multivariate analyses, only the development of cervical haematoma was statistically significantly correlated to the BMI value. Patients with high BMI had a lower risk of cervical haematoma (P = 0.045, OR 0.797, 95% CI 0.638-0.995). CONCLUSIONS This study showed that obesity, in the field of thyroid surgery, is not associated with any increase of postoperative complications. Thus, it is possible to conclude that thyroidectomy can be performed safely in obese patients. Our result about operative times had no clinical significance.
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Affiliation(s)
- Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy.
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
| | - Federico Cappellacci
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
| | - Michele Guido Podda
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
| | - Giorgio Romano
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, 90127, Palermo, Italy
| | - Enrico Erdas
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, "Policlinico Universitario Duilio Casula", 09042, Monserrato, CA, Italy
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20
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Üstün M, Karaca AC, Birol I, Uslu G, Atici SD, Aydin C. The relationship between thyroidectomy complications and body mass index. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2020; 66:1573-1576. [PMID: 33295412 DOI: 10.1590/1806-9282.66.11.1573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/11/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Obesity is a growing public health problem associated with many comorbid diseases. The aim of this study was to evaluate the relationship between body mass index and complications of thyroidectomy. METHODS Patients who underwent total thyroidectomy between January 2015 and December 2018 were enrolled. Patients were divided into two groups, i.e., BMI <25 (group A) and BMI≥ 25 (group B). Demographics, operative time, and complications were retrospectively reviewed. RESULTS The study included 145 patients (66 in Group A and 79 in Group B). There was no significant difference between the two groups in terms of age (p=0.330) and gender (p=0.055). No surgical site infection and bleeding complications were observed in any patients. The mean operative time was 148.4 minutes (90-235) in Group A and 153.4 minutes (85-285) in Group B (p=0.399). Transient hypocalcemia was observed in 25 (37.9%) patients in group A, and 23 (29.1%) patients in Group B (p = 0.291). Permanent hypocalcemia was not observed in any patient in group A, and in 2 patients in Group B (2.5%) (p = 0.501). Transient recurrent nerve palsy was observed in 1 (1.5%) patient in Group A and in 3 (3.8%) patients in Group B (p=0.626). None of the patients had permanent recurrent nerve palsy. Parathyroid autotransplantation was performed on 1 patient (1.5%) in group A and on 7 (8.9%) patients in Group B (p=0.055). CONCLUSION We think there is no relationship between a high BMI and thyroidectomy complications, and surgery can also be performed safely in this patient group.
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Affiliation(s)
- Mehmet Üstün
- University of Health Sciences Tepecik Training and Research Hospital, Department of General Surgery, Izmir, Turkey
| | - Avni Can Karaca
- Izmir University of Economics Faculty of Medicine, Department of General Surgery, Izmir, Turkey
| | - Ihsan Birol
- 25 Aralik State Hospital Department of General Surgery, Gaziantep, Turkey
| | - Gülberk Uslu
- University of Health Sciences Tepecik Training and Research Hospital, Department of General Surgery, Izmir, Turkey
| | - Semra Demirli Atici
- University of Health Sciences Tepecik Training and Research Hospital, Department of General Surgery, Izmir, Turkey
| | - Cengiz Aydin
- University of Health Sciences Tepecik Training and Research Hospital, Department of General Surgery, Izmir, Turkey
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Frey S, Blanchard C, Caillard C, Drui D, Hamy A, Trésallet C, Mirallié É. Thyroid surgery in obese patients: A review of the literature. J Visc Surg 2020; 157:401-409. [PMID: 32591245 DOI: 10.1016/j.jviscsurg.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The incidence of obesity in the general population has tripled in the past four decades. The number of bariatric surgeries performed annually has quadrupled in the past ten years due to this obesity epidemic. Concomitantly, the number of patients who are obese or who have undergone bariatric surgery and have become candidates for thyroid surgery has also increased considerably. Among patients undergoing thyroidectomy in the French population, the proportion of obese patients currently represents 10 to 20%. In addition, the frequency of benign and malignant thyroid pathologies seems to be increased by obesity, with a Hazard Ratio of around 1.8 for thyroid cancers in obese women. While obesity does not seem to influence the specific post-operative morbidity of thyroidectomy, a history of malabsorptive bariatric surgery should encourage the greatest caution in patients who need to undergo thyroid surgery since it is associated with a significant risk of severe hypocalcemia (>60% in some studies) requiring intravenous calcium supplementation in about 20% of cases. In the latter situation, peri-operative vitamin D-calcium supplementation is essential. In addition, the replacement dose of Levothyroxine (T4) intended for replacement must also be adapted in obese patients, calculated not from the actual weight but from the ideal weight. The objective of this review is to discuss the influence of obesity on the evolution of nodular and neoplastic thyroid pathologies, on the morbidity of thyroid surgery as well as on post-operative drug treatments. The impact of bariatric surgery on these different aspects is also discussed.
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Affiliation(s)
- S Frey
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des maladies de l'Appareil Digestif, Hôtel Dieu, CHU Nantes, Place Alexis Ricordeau, 44093 Nantes cedex 1, France; University of Nantes, quai de Tourville, 44000 Nantes, France
| | - C Blanchard
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des maladies de l'Appareil Digestif, Hôtel Dieu, CHU Nantes, Place Alexis Ricordeau, 44093 Nantes cedex 1, France; University of Nantes, quai de Tourville, 44000 Nantes, France; L'institut du thorax, inserm, CNRS, UNIV Nantes, Nantes, France
| | - C Caillard
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des maladies de l'Appareil Digestif, Hôtel Dieu, CHU Nantes, Place Alexis Ricordeau, 44093 Nantes cedex 1, France
| | - D Drui
- L'institut du thorax, inserm, CNRS, UNIV Nantes, Nantes, France; Endocrinologie, Maladies Métaboliques et Nutrition, CHU de Nantes, Hôpital Laënnec, Boulevard Jacques Monod, 44800 Saint-Herblain, France
| | - A Hamy
- Chirurgie Digestive et Endocrinienne, CHU d'Angers, 49933 Angers cedex 09, France
| | - C Trésallet
- Service de Chirurgie Digestive, Bariatrique et Endocrinienne. Hôpitaux Universitaires Paris Seine-Saint-Denis. Avicenne Hospital, 125, rue de Stalingrad, 93000 Bobigny, France
| | - É Mirallié
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des maladies de l'Appareil Digestif, Hôtel Dieu, CHU Nantes, Place Alexis Ricordeau, 44093 Nantes cedex 1, France; University of Nantes, quai de Tourville, 44000 Nantes, France.
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Taye A, Inabnet WB, Pan S, Carty SE, Cotton T, Czako P, Doherty G, Gauger P, Hanks J, McAneny D, Milas M, Perrier N, Rosen J, Schneider DF, Sharma J, Siperstein A, Sosa JA. Post-thyroidectomy emergency room visits and readmissions: Assessment from the Collaborative Endocrine Surgery Quality Improvement Program (CESQIP). Am J Surg 2020; 220:813-820. [PMID: 32115176 DOI: 10.1016/j.amjsurg.2020.02.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/07/2020] [Accepted: 02/17/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study analyzed independent factors associated with post-thyroidectomy Emergency Room (ER) visits and Hospital Readmissions (HR). METHODS This is a retrospective review from the CESQIP registry of 8381 thyroidectomy patients by 173 surgeons at 46 institutions. A total of 7142 ER visits and 7265 HR were analyzed. Multivariable logistic regression analysis was performed to determine the risk factors for an ER visit or HR. RESULTS Within 30-days of surgery, rates of all ER visits were 3.4% (n = 250) and all HR were 2.3% (n = 170). Hypocalcemia was the reason for 21.9% of ER encounters and 36.4% of HR. BMI >40 kg/m2 was a risk factor for both ER visit (OR1.86) and HR (OR1.94). Surgical duration >3 h (OR2.63), and transection of recurrent laryngeal nerve (OR4.58) were risk factors for HR. CONCLUSIONS Strategies to decrease hypocalcemia and improve perioperative care of patients with BMI >40 kg/m2 may improve post-thyroidectomy outcome.
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Affiliation(s)
- Aida Taye
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | - Stephanie Pan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Sally E Carty
- Department of Surgery, University of Pittsburgh School of Medicine at University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Travis Cotton
- Department of Surgery, Brown University Warren Alpert School of Medicine at University Surgical Associates, Providence, RI, USA.
| | - Peter Czako
- Department of Surgery, Oakland University William Beaumont School of Medicine at Royal Oak Surgical Associates, Royal Oak, MI, USA.
| | - Gerard Doherty
- Department of Surgery, Harvard Medical School at Brigham and Women's Hospital, Boston, MA, USA.
| | - Paul Gauger
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA.
| | - John Hanks
- Department of Surgery, University of Virginia School of Medicine at University of Virginia Health Systems, Charlottesville, VA, USA.
| | - David McAneny
- Department of Surgery, Boston University School of Medicine at Boston Medical Center, Boston, MA, USA.
| | - Mira Milas
- Department of Surgery, University of Arizona College of Medicine at Banner-University Medical Center, Phoenix, AZ, USA.
| | - Nancy Perrier
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Jennifer Rosen
- Department of Surgery, MedStar Washington Hospital Center, Washington, DC, USA.
| | - David F Schneider
- Department of Surgery, University of Wisconsin School of Medicine, Madison, WI, USA.
| | - Jyotirmay Sharma
- Department of Surgery, Emory University School of Medicine at Emory University Hospital, Atlanta, USA.
| | | | - Julie Ann Sosa
- Department of Surgery, University of California San Francisco-UCSF, San Francisco, CA, USA.
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Jin QF, Fang QG, Qi JX, Li P. Impact of BMI on Complications and Satisfaction in Patients With Papillary Thyroid Cancer and Lateral Neck Metastasis. Cancer Control 2020; 26:1073274819853831. [PMID: 31480878 PMCID: PMC6727094 DOI: 10.1177/1073274819853831] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This study investigates the effect of body mass index (BMI) on complications and satisfaction in patients who underwent thyroidectomy and lateral neck dissection. METHODS We retrospectively reviewed 386 patients with papillary thyroid cancer who underwent total thyroidectomy and lateral neck dissection between January 2013 and December 2016. We compared variables including population characteristics, subjective satisfaction, and complications in nonobese (BMI < 28.0 kg/m2) and obese (BMI ≥ 28.0 kg/m2) patients. RESULTS Obesity was associated with an increased risk of postoperative hemorrhage (POH) (P = .014), accessory nerve injury (P < .001), operative time (P < .001) and infection (P = .013). However, obese patients had higher subjective satisfaction and Vancouver Scar Scale (VSS) scores (P < .05). CONCLUSIONS Obesity was associated with increased risk of POH, injury of the SAN, and infection. Interestingly, we found that obese patients had higher subjective satisfaction and VSS scores.
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Affiliation(s)
- Qiu-Feng Jin
- 1 Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, People's Republic of China
| | - Qi-Gen Fang
- 1 Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, People's Republic of China
| | - Jin-Xing Qi
- 1 Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, People's Republic of China
| | - Peng Li
- 1 Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province, People's Republic of China
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Tai DKC, Kim HY, Park D, You J, Kim HK, Russell JO, Tufano RP. Obesity May Not Affect Outcomes of Transoral Robotic Thyroidectomy: Subset Analysis of 304 Patients. Laryngoscope 2019; 130:1343-1348. [PMID: 31408213 DOI: 10.1002/lary.28239] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/09/2019] [Accepted: 07/26/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Obesity is an increasing health concern worldwide. It has been associated with perioperative complications that could affect patient outcomes. Our aim was to compare surgical outcomes in obese and nonobese patients after transoral robotic thyroid (TORT) surgery. STUDY DESIGN Retrospective cohort study. METHODS A total of 304 consecutive patients who underwent TORT between January 2012 to December 2017 were included in the study. Patients were divided into two groups according to their body mass index (BMI): BMI < 30 kg/m2 and BMI ≥30 kg/m2 . Patient demographics, operative extent, pathological data, surgical outcomes, and postoperative complications were included and analyzed. A χ2 test was used to compare categorical variables, and a Student t test was used to compare changes of continuous variables between groups. Statistical significance was conferred by a two-tailed P value of ≤.05. RESULTS There were 290 patients in the non-obese group and 14 patients in the obese group. There was no statistically significant difference between the two groups in terms of patient demographics, operative procedure, or pathological characteristics. The only statistically significant difference was for lymph node dissection (P = .012); however, for both groups, unilateral central node dissection was the most common procedure. There was also no statistically significant difference found for operative time, length of stay, pain score, or postoperative complications including TORT-specific complications such as oral commissure tear and general complications such as recurrent nerve injury. CONCLUSIONS This initial experience shows that TORT appears to be a safe and feasible option for obese patients pursuing scarless thyroid surgery. LEVEL OF EVIDENCE NA Laryngoscope, 130:1343-1348, 2020.
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Affiliation(s)
- Dora Kai Chun Tai
- Department of Surgery, Queen Elizabeth Hospital, Jordan, Kowloon, Hong Kong
| | - Hoon Yub Kim
- Department of Surgery, Korea University Thyroid Center, Korea University College of Medicine, Seoul, South Korea
| | - Dawon Park
- Department of Surgery, Korea University Thyroid Center, Korea University College of Medicine, Seoul, South Korea
| | - Jiyoung You
- Department of Surgery, Korea University Thyroid Center, Korea University College of Medicine, Seoul, South Korea
| | - Hong Kyu Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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25
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Impact of body mass index on robotic transaxillary thyroidectomy. Sci Rep 2019; 9:8955. [PMID: 31222123 PMCID: PMC6586661 DOI: 10.1038/s41598-019-45355-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 06/03/2019] [Indexed: 02/01/2023] Open
Abstract
Obesity is associated with increased operating times and higher complication rates in many types of surgery. Its impact on robotic thyroidectomy however, is not well documented. The aim of this study was to investigate the relationship between body mass index (BMI) and robotic transaxillary thyroidectomy (RTAT). A retrospective review of prospectively collected data of all patients who underwent RTAT at Yonsei University Health System from October 2007 to December 2014 was performed. Patients were divided into three groups based on BMI (Group 1: BMI < 25, Group 2: BMI 25-29.99, Group 3: BMI ≥ 30), and compared. A total of 3697 patients were analyzed. No differences between the three groups were observed in clinicopathological factors, extent of surgery or length of stay. After multivariate analysis, only seroma and transient voice hoarseness were related to increasing BMI. Total operative time was significantly longer for Group 3 patients with less-than-bilateral total thyroidectomy (BTT), but was not significantly different for patients with BTT. Although obese patients undergoing RTAT have a slightly higher risk of seroma, transient voice hoarseness, and longer operative times, BMI did not influence the other important surgical outcomes of thyroidectomy. Therefore, obesity should not be a contraindication for performing RTAT.
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26
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Cipolla C, Graceffa G, Calamia S, Fiorentino E, Pantuso G, Vieni S, Latteri M. The value of total thyroidectomy as the definitive treatment for Graves' disease: A single centre experience of 594 cases. J Clin Transl Endocrinol 2019; 16:100183. [PMID: 30815364 PMCID: PMC6377402 DOI: 10.1016/j.jcte.2019.100183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/30/2019] [Accepted: 02/07/2019] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Thyroidectomy is the preferred approach as the definitive treatment for Graves' disease. The outcomes for total thyroidectomy in a large series of 594 patients, who were observed in the last decade, will be presented in this study. METHODS The study concerned a retrospective review of 594 patients, undergoing a total thyroidectomy for Graves' disease. The incidence of complications and outcomes on hyperthyroidism and correlated symptoms resolution were also evaluated. RESULTS The mean age of the patients was of 44.7 ± 12.7 years and 456 patients (76.7%) were females. The mean gland weight was 67.3 ± 10.8 g (range: 20-350 g) and, in 397 patients (66.8%), the gland weighed >40 g. The mean operative time was 125 ± 23.1 min (range: 65-212 min). Temporary and permanent hypocalcaemia developed in 241 (40.6%) and 3 patients (0.5%), respectively. Temporary and permanent recurrent laryngeal nerve palsy were recorded in 31 (5.2%) and 1 patients (0.16%) respectively. No patient developed a thyroid storm. On multivariate analysis, patient age ≤50 years (Odds ratio: 1; 95% Confidence Interval: 0.843-0.901) and thyroid weight >40 g (Odds ratio: 1; 95%, Confidence Interval: 0.852-0.974), were mainly associated with the occurrence of complications. CONCLUSION This high-volume surgeon experience demonstrates that total thyroidectomy is a safe and effective treatment for Graves' disease. It is associated with a very low incidence rate of post-operative complications, most of which are transitory; therefore, it offers a rapid and definitive control of hyperthyroidism and its related symptoms.
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Affiliation(s)
- Calogero Cipolla
- University of Palermo, Department of Surgical Oncological and Oral Sciences, Division of General and Oncological Surgery, Palermo, Italy
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27
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Malik MZ, Mirza AA, Farooqi SA, Chaudhary NA, Waqar M, Bhatti HW. Role of Preoperative Administration of Vitamin D and Calcium in Postoperative Transient Hypocalcemia after Total Thyroidectomy. Cureus 2019; 11:e4579. [PMID: 31281762 PMCID: PMC6605693 DOI: 10.7759/cureus.4579] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Thyroid surgery is one of the most frequently performed surgical procedures worldwide. Total thyroidectomy is a recommended procedure for most of the thyroid diseases. The most common complication resulting after this surgery is transient hypocalcemia - the incidence is 24% - which increases the morbidity rate and increases the length of stay in the hospital. The objective of our study was to compare the frequency of transient hypocalcemia after vitamin D and calcium supplementation with the control group for patients undergoing total thyroidectomy. Patients and methods It was a randomized controlled trial conducted at Department of Surgery, Pakistan Atomic Energy Commission General Hospital, Islamabad, Pakistan from January 2017 to July 2017. A total of 92 patients of both genders undergoing total thyroidectomy were included in the study. Patients undergoing reoperation for thyroid disease, American Society of Anesthesiologists (ASA) grade 3 or above, patients with chronic renal failure, preoperative hypocalcemia or hypercalcemia were excluded. The patients were sorted into two groups by lottery method; Group 1 in which Vitamin D (2,00,000 IU) and calcium (1 gm) was given 24 hours preoperatively. Group 2 was the control group. Total thyroidectomy was done and serum calcium levels were evaluated immediately after surgery on day two, seven and on the 30th day. The final outcome was measured at one month. Data was analyzed via the Statistical Package for Social Sciences version 22.0 (IBM Corp, Armonk, NY, USA). P value ≤ 0.05 was considered significant. Results The age ranged from 18 to 65 years with the mean age of 38.673 ± 8.63 years in group 1 while 41.217 ± 9.52 years in group 2, mean preoperative calcium level was 9.482 ± 0.49 mg/dl in group 1 and 9.678 ± 0.54 mg/dl in group 2. Hypocalcemia was seen in 3 (6.5%) in group 1 as compared to 12 (26.1%) patients in group 2 (p = 0.011). Conclusion Preoperative oral calcium and vitamin D supplements may prevent postoperative hypocalcemia, allowing a safe and early discharge. This will ultimately lead to improved patient satisfaction and significant cost savings.
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Affiliation(s)
- Muhammad Z Malik
- Surgery, Pakistan Atomic Energy Commission General Hospital, Islamabad, PAK
| | - Ahsan A Mirza
- Surgery, Pakistan Atomic Energy Commission General Hospital, Islamabad, PAK
| | | | | | - Mahnoor Waqar
- Surgery, Rawalpindi Medical University, Rawalpindi, PAK
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D'Orazi V, Sacconi A, Trombetta S, Karpathiotakis M, Pichelli D, Di Lorenzo E, Ortensi A, Urciuoli P, Biffoni M, Ortensi A. May predictors of difficulty in thyroid surgery increase the incidence of complications? Prospective study with the proposal of a preoperative score. BMC Surg 2019; 18:116. [PMID: 31074389 PMCID: PMC7402572 DOI: 10.1186/s12893-018-0447-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/15/2018] [Indexed: 12/20/2022] Open
Abstract
Background Although thyroidectomy is one of the most common surgical procedures performed worldwide, some permanent complications, despite the considerably reducing incidence, may affect dramatically the patients quality of life. The purpose of this study is to evaluate whether factors identified preoperatively and expressed in a score could be predictors of major surgical difficulty during total thyroidectomy and influence the incidence of complications. Methods A total of 164 patients who underwent total thyroidectomy were examined. For each patient we calculated a preoperative score, including seven parameters, which we evaluated to be predictors of difficulty in thyroid surgery, that is, sex, body mass index (BMI), neck length, neck extension, thyroid gland volume, thyroiditis, and increased parenchymal vascularization. The overall score was also compared with peri- and post-operative factors describing objectively the difficulty in thyroid surgery. These factors are the duration of the operation, the length of hospitalization, the incidence of complications such as hemorrhage, hypoparathyroidism, and recurrent laryngeal nerve injuries. Results There was no statistically significant association between our score and either the percentage of postoperative complications or the length of hospitalization. The operative time was the only variable remarkably associated with the score value (p < 0.00001). Comparing the duration of the operation with each of the preoperative predictive factors, we found that none of the factors reached the value of statistical significance, but a close association could be noted with the thyroid volume and the BMI. Conclusions In our study, predictors of difficulty in thyroidectomy did not affect morbidity rates, as suggested by previous studies, but only operative times, which were significantly increased in patients with higher score. Although our results have limited statistical significance, they allow us to confirm the fundamental role of a systematic use of optical magnification and microsurgical technique in thyroidectomy. Further studies, with a larger cohort of patients, are needed to validate our results and to formulate a universally accepted predictive score of difficulty in thyroidectomy preoperatively.
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Affiliation(s)
- Valerio D'Orazi
- Department of Surgical Sciences, "Sapienza" University, Viale Regina Elena 324, 00161, Rome, Italy. .,Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Rome, Italy.
| | - Andrea Sacconi
- Translational Oncogenomics Unit, Molecular Medicine Area, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Silvia Trombetta
- Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Rome, Italy
| | - Menelaos Karpathiotakis
- Department of Surgical Sciences, "Sapienza" University, Viale Regina Elena 324, 00161, Rome, Italy.,Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Rome, Italy
| | - Daniele Pichelli
- Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Rome, Italy
| | - Enrico Di Lorenzo
- Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Rome, Italy.,Department of General Microsurgery and Hand, Surgery Section of phoniatrics and speech therapy, "Fabia Mater" Hospital, Rome, Italy
| | - Alice Ortensi
- Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Rome, Italy.,Department of General Microsurgery and Hand Surgery, Section of physiotherapy, "Fabia Mater" Hospital, Rome, Italy
| | - Paolo Urciuoli
- Department of Surgical Sciences, "Sapienza" University, Viale Regina Elena 324, 00161, Rome, Italy
| | - Marco Biffoni
- Department of Surgical Sciences, "Sapienza" University, Viale Regina Elena 324, 00161, Rome, Italy
| | - Andrea Ortensi
- Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Rome, Italy.,Chief of Department of General Microsurgery and Hand Surgery, "Fabia Mater" Hospital, Rome, Italy
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Blanchard C, Bannani S, Pattou F, Brunaud L, Hamy A, Christou N, Mathonnet M, Dahan M, Prades J, Landecy G, Dernis H, Sebag F, Babin E, Bizon A, Lifante J, Jegoux F, Volteau C, Caillard C, Riche V, Mirallié É. Impact of body mass index on post‐thyroidectomy morbidity. Head Neck 2019; 41:2952-2959. [DOI: 10.1002/hed.25773] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/27/2019] [Accepted: 04/02/2019] [Indexed: 11/07/2022] Open
Affiliation(s)
- Claire Blanchard
- CHU de NantesClinique de Chirurgie Digestive et Endocrinienne (CCDE) Nantes Cedex 1 France
| | - Sahar Bannani
- CHU de NantesClinique de Chirurgie Digestive et Endocrinienne (CCDE) Nantes Cedex 1 France
| | - François Pattou
- CHU LilleUniversité de Lille, Chirurgie Générale et Endocrinienne Lille France
| | - Laurent Brunaud
- CHU Nancy ‐ Hôpital de BraboisService de Chirurgie Digestive, Hépato‐Biliaire, et Endocrinienne Nancy France
| | - Antoine Hamy
- CHU AngersChirurgie Digestive et Endocrinienne Angers Cedex 09 France
| | - Niki Christou
- CHU de Limoges ‐ Hôpital DupuytrenChirurgie Digestive, Générale et Endocrinienne Limoges Cedex France
| | - Muriel Mathonnet
- CHU de Limoges ‐ Hôpital DupuytrenChirurgie Digestive, Générale et Endocrinienne Limoges Cedex France
| | - Marcel Dahan
- CHU de Toulouse ‐ Hôpital LarreyChirurgie Thoracique, Pôle Voies Respiratoires Toulouse Cedex 9 France
| | - Jean‐Michel Prades
- CHU Saint‐Etienne ‐ Hôpital NordORL et Chirurgie cervico‐faciale et plastique Saint‐Etienne Cedex 2 France
| | - Gérard Landecy
- CHU de Besançon ‐ Hôpital Jean MinjozChirurgie digestive Besançon Cedex France
| | - Henri‐Pierre Dernis
- Centre Hospitalier du MansService ORL et chirurgie cervico‐faciale Le Mans Cedex 9 France
| | - Fréderic Sebag
- AP‐HM ‐ Hôpital de La TimoneChirurgie Générale Marseille France
| | - Emmanuel Babin
- CHU de CaenORL et chirurgie cervico‐faciale Caen Cedex 9 France
| | - Alain Bizon
- CHU d'AngersORL et chirurgie cervico‐faciale Angers Cedex 09 France
| | - Jean‐Christophe Lifante
- Centre Hospitalier Lyon‐SudChirurgie Générale, Endocrinienne, Digestive et Thoracique Pierre Bénite Cedex France
| | - Frank Jegoux
- CHU de Rennes ‐ Hôpital PontchaillouService ORL et chirurgie maxillo‐faciale Rennes Cedex 9 France
| | | | - Cécile Caillard
- CHU de NantesClinique de Chirurgie Digestive et Endocrinienne (CCDE) Nantes Cedex 1 France
| | - Valery‐Pierre Riche
- Direction de Recherche cliniqueDépartement Partenariats et Innovation, cellule Innovation Nantes Cedex 1 France
| | - Éric Mirallié
- CHU de NantesClinique de Chirurgie Digestive et Endocrinienne (CCDE) Nantes Cedex 1 France
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Feng JW, Yang XH, Wu BQ, Sun DL, Jiang Y, Qu Z. Influence of Body Mass Index on the Clinicopathologic Features of Papillary Thyroid Carcinoma. Ann Otol Rhinol Laryngol 2019; 128:625-632. [PMID: 30841713 DOI: 10.1177/0003489419834314] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Epidemiologic studies have demonstrated an increased risk for papillary thyroid carcinoma (PTC) with increasing body mass index (BMI). However, the relationships between excess weight and the behavior of PTC are inconsistent. The aim of this study was to evaluate the impact of excess weight on clinicopathologic features of PTC and on patient outcomes. METHODS Data from 417 patients with PTC who underwent total thyroidectomy with cervical lymph node dissection were retrospectively analyzed. On the basis of World Health Organization standardized categories of BMI, patients were divided into 4 groups: underweight, normal weight, overweight, and obese. Histopathologic tumor features, stage at diagnosis, and disease status were determined by chart review. Logistic regression models were used to define associations between BMI and clinicopathologic features of PTC. Cox proportional-hazards models were used to assess associations between BMI and locoregional recurrence. RESULTS Overweight (odds ratio [OR], 3.90; P = .040) and obesity (OR, 9.19; P = .012) were independent predictors of vascular invasion. Furthermore, obesity (OR, 6.14; P = .004) was an independent predictor of extrathyroidal invasion. During follow-up (median, 29 months; range, 5-87 months), 48 patients (11.5%) experienced locoregional recurrence. There were no significant differences in locoregional recurrence of PTC among BMI groups. When adjusted for other confounding factors, extrathyroidal invasion (OR, 8.35; P < .001), vascular invasion (OR, 3.57; P < .001), cervical lymph node metastasis (OR, 3.71; P = .009), and advanced tumor-node-metastasis stage (OR, 3.81; P < .001) were identified as independent factors for locoregional recurrence. CONCLUSIONS Higher BMI was associated with extrathyroidal invasion and vascular invasion in patients with PTC, which suggests that excess weight is associated with aggressive clinicopathologic features of PTC. But patients with higher BMI did not have an increased risk for developing postoperative complications and locoregional recurrence.
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Affiliation(s)
- Jia-Wei Feng
- 1 Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xing-Hai Yang
- 1 Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Bao-Qiang Wu
- 1 Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Dong-Lin Sun
- 1 Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Yong Jiang
- 1 Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Zhen Qu
- 1 Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
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31
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Di Domenico M, Pinto F, Quagliuolo L, Contaldo M, Settembre G, Romano A, Coppola M, Ferati K, Bexheti-Ferati A, Sciarra A, Nicoletti GF, Ferraro GA, Boccellino M. The Role of Oxidative Stress and Hormones in Controlling Obesity. Front Endocrinol (Lausanne) 2019; 10:540. [PMID: 31456748 PMCID: PMC6701166 DOI: 10.3389/fendo.2019.00540] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/19/2019] [Indexed: 12/15/2022] Open
Abstract
The accumulation of adipose tissue in the body occurs because the energy introduced with food and drink exceeds that expense, but to understand why this imbalance is established and why it is maintained over time, it is important to consider the main causes and risk factors of excess weight. In this review, we will refer to the main factors linked to obesity, starting from oxidative stress to hormonal factors including the role of obesity in breast cancer. Among the many hypotheses formulated on the etiopathology of obesity, a key role can be attributed to the relationship between stress oxidative and intestinal microbiota. Multiple evidences tend to show that genetic, epigenetic, and lifestyle factors contribute to determine in the obese an imbalance of the redox balance correlated with the alteration of the intestinal microbial flora. Obesity acts negatively on the wound healing, in fact several studies indicate morbid obesity significantly increased the risk of a post-operative wound complication and infection. Currently, in the treatment of obesity, medical interventions are aimed not only at modifying caloric intake, but also to modulate and improve the composition of diet with the aim of rebalancing the microbiota-redox state axis.
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Affiliation(s)
- Marina Di Domenico
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
- Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA, United States
| | - Federica Pinto
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Lucio Quagliuolo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Maria Contaldo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giuliana Settembre
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Antonio Romano
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mario Coppola
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Kenan Ferati
- Faculty of Medicine, University of Tetovo, Tetovo, Macedonia
| | | | - Antonella Sciarra
- Department of Translational Medicad Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giovanni Francesco Nicoletti
- Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giuseppe Andrea Ferraro
- Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
- *Correspondence: Giuseppe Andrea Ferraro
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Farag M, Ibraheem K, Garstka ME, Shalaby H, DuCoin C, Killackey M, Kandil E. Thyroid surgery and obesity: Cohort study of surgical outcomes and local specific complications. Am J Surg 2018; 217:142-145. [PMID: 30389117 DOI: 10.1016/j.amjsurg.2018.07.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/15/2018] [Accepted: 07/20/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Obesity is associated with numerous complications after elective general surgeries. The aim is to compare surgical outcomes and local specific complications in obese and non-obese patients after thyroid surgery. METHODS Retrospective study over a 3-year period at a North American academic institution. Outcome measures were operative time, estimated blood loss, hospital length of stay, and local specific complications (hypocalcemia, recurrent laryngeal nerve injury, wound hematoma, wound seroma, and chyle leakage). RESULTS A total of 469 patients were included (mean [SD] age, 50.11 [15.01] years; mean [SD] BMI, 30.5 [8.3] kg/m2; 207 [44.14%] obese). There was no difference in operative time (125.7 vs. 129.6, p = 0.52), estimated blood loss (16.88 vs. 14.56, p = 0.28), or hospital length of stay (0.95 vs. 0.95, p = 0.96). Overall, there was no difference in the rates of local specific complications between the two groups. CONCLUSIONS Obesity is not associated with adverse outcomes in patients undergoing thyroid surgery.
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Affiliation(s)
- Mahmoud Farag
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Kareem Ibraheem
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Meghan E Garstka
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Hosam Shalaby
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Christopher DuCoin
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mary Killackey
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
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Lee YJ, Wong A, Filimonov A, Sangal NR, Yeon Chung S, Hsueh WD, Baredes S, Eloy JA. Impact of Body Mass Index on Perioperative Outcomes of Endoscopic Pituitary Surgery. Am J Rhinol Allergy 2018; 32:404-411. [PMID: 30033742 DOI: 10.1177/1945892418787129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Endoscopic pituitary surgery (EPS) is increasingly being used for the treatment of pituitary lesions. Obesity is a growing epidemic in our nation associated with numerous comorbidities known to impact surgical outcomes. We present a multi-institutional database study evaluating the association between body mass index (BMI) and postsurgical outcomes of EPS. Methods Patients who underwent EPS from 2005 to 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Preoperative variables, comorbidities, and postoperative outcomes, such as 30-day complications, morbidity, and mortality, were analyzed. Results A total of 789 patients were analyzed, of which 382 were obese (BMI ≥ 30) (48.4%). No difference in reoperation rate ( P = .928) or unplanned readmission rates ( P = .837) was found between the obese versus nonobese group. A higher overall complication rate was observed in the obese group compared to the nonobese counterparts ( P = .005). However, when separated into surgical complications (3.7% vs 1.5%, P = .068) and medical complications (7.6% vs 3.9%, P = .027), only medical complications, specifically pneumonia, remained significantly different. EPS on obese patients was also associated with prolonged operating time (154.8 min vs 141.0 min, P = .011). Conclusions EPS may be a safe treatment option for pituitary lesions in the obese population. Although obese patients undergoing EPS are at increased risk of medical complications and prolonged operating times, this did not influence mortality, reoperation, or readmission rate.
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Affiliation(s)
- Yung-Jae Lee
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Anni Wong
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Andrey Filimonov
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Neel R Sangal
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Sei Yeon Chung
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Wayne D Hsueh
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Soly Baredes
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,2 Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jean Anderson Eloy
- 1 Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,2 Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey.,3 Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,4 Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
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Thomas CM, Mattingly JK, Hendrickse A, Song JI. Case Report of a Massive Retropharyngeal Goiter Resulting in Laryngeal Compression. ACTA ACUST UNITED AC 2017; 9:178-181. [PMID: 28542048 DOI: 10.1213/xaa.0000000000000560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This is a rare presentation of a morbidly obese male with a massive retropharyngeal goiter causing laryngeal compressive symptoms and unique airway management challenges. Flexible laryngoscopy revealed a retropharyngeal mass circumferentially compressing the oropharynx and supraglottis and preventing the visualization of the glottis. Awake tracheostomy was performed before total thyroidectomy. Airway compression from a goiter typically results from substernal extension, which usually does not cause difficulty with endotracheal intubation. Extensive retropharyngeal extension can cause supraglottic obstruction of the airway. In these cases, optimal management consists of a closely coordinated approach between anesthesia and surgery teams to establish a surgical airway.
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Affiliation(s)
- Carissa M Thomas
- From the Departments of *Otolaryngology-Head and Neck Surgery and †Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado
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Khan MN, Russo J, Spivack J, Pool C, Likhterov I, Teng M, Genden EM, Miles BA. Association of Body Mass Index With Infectious Complications in Free Tissue Transfer for Head and Neck Reconstructive Surgery. JAMA Otolaryngol Head Neck Surg 2017; 143:574-579. [PMID: 28301644 PMCID: PMC5824233 DOI: 10.1001/jamaoto.2016.4304] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/13/2016] [Indexed: 12/15/2022]
Abstract
Importance Elevated body mass index (BMI) has been proposed as a risk factor for morbidity and mortality among patients undergoing surgery. Conversely, an elevated BMI may confer a protective effect on perioperative morbidity. Objective To examine whether an elevated BMI is an independent risk factor for perioperative and postoperative infectious complications after free tissue transfer in head and neck reconstructive surgery. Design, Setting, and Participants This cohort study included patients undergoing major head and neck surgery requiring free tissue transfer at a tertiary care center. Data were collected for 415 patients treated from January 1, 2007, through December 31, 2014. Main Outcomes and Measures The outcome of interest was postoperative infection and complications after head and neck surgery using free flaps. Covariates considered for adjustment in the statistical model included alcohol consumption (defined as >5 drinks per day [eg, 360 mL of beer, 150 mL of wine, or 45 mL of 80-proof spirits]), type 2 diabetes, prior radiotherapy, anesthesia time, hypothyroidism, smoking, American Society of Anesthesiologists classification, antibiotic regimen received (defined as a standard regimen of a first- or second-generation cephalosporin with or without metronidazole hydrochloride vs an alternative antibiotic regimen for patients allergic to penicillin), and primary surgeon. A multiple logistic regression model was developed for the incidence of the infection end point as a function of elevated BMI (>30.0). Results Among the 415 patients included in this study (277 men [66.7%] and 138 women [33.2%]; mean [SD] age, 61.5 [13.9] years), type 2 diabetes and use of an alternative antibiotic regimen were found to be independently associated with increased infectious complications after free flap surgery of the head and neck, with estimated odds ratios of 2.78 (95% CI, 1.27-6.09) and 2.67 (95% CI, 1.14-6.25), respectively, in the multiple logistic regression model. However, a high BMI was not found to be statistically significant as an independent risk factor for postoperative infectious complication (estimated odds ratio, 1.19; 95% CI, 0.48-2.92). Conclusions and Relevance Elevated BMI does not seem to play a role as an independent risk factor in postoperative complications in free tissue transfer in head and neck surgery.
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Affiliation(s)
- Mohemmed N. Khan
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jack Russo
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John Spivack
- Department of Health Policy and Statistics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christopher Pool
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ilya Likhterov
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marita Teng
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eric M. Genden
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brett A. Miles
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Lee HS, Chai YJ, Kim SJ, Choi JY, Lee KE. Influence of body habitus on the surgical outcomes of bilateral axillo-breast approach robotic thyroidectomy in papillary thyroid carcinoma patients. Ann Surg Treat Res 2016; 91:1-7. [PMID: 27433458 PMCID: PMC4942533 DOI: 10.4174/astr.2016.91.1.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 03/25/2016] [Accepted: 04/11/2016] [Indexed: 01/11/2023] Open
Abstract
Purpose Obesity is associated with a number of medical comorbidities and is considered a risk factor for surgical complications. The purpose of this study was to analyze the influence of body habitus including obesity on the surgical outcomes of the Bilateral axillo-breast approach (BABA) robotic thyroidectomy (RoT) in papillary thyroid carcinoma (PTC) patients. Methods The medical records of 456 PTC patients who underwent BABA RoT between January 2011 and December 2012 were reviewed, and 310 women PTC patients who had undergone BABA robotic total thyroidectomy with central lymph node dissection were examined. Body habitus were evaluated by measuring body mass index (BMI), body surface area, and neck circumference. We divided the patients into BMI < 25 kg/m2 and BMI ≥ 25 kg/m2 groups. Clinicopathological data, surgical outcomes, and postoperative complications were evaluated. Results Clinicopathological characteristics did not differ between the 2 BMI groups. The creation of working space time (P = 0.210) and other surgical outcomes showed no significant differences between the groups. There were no statistically significant differences between body habitus indexes and postoperative length of hospital stay, number of retrieved central lymph nodes, postoperative thyroglobulin levels, occurrence of hypoparathyoidism, recurrent laryngeal nerve injury and wound complication. Conclusion Patient with large body habitus undergoing BABA RoT were not at an increased risk of surgical complications and showed good surgical outcomes. BABA RoT may be a good alternative operative method for PTC patients for whom cosmetic outcome is an important consideration.
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Affiliation(s)
- Hee Seung Lee
- Department of Surgery, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Young Jun Chai
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.; Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Su-Jin Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.; Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.; Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea
| | - June Young Choi
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.; Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyu Eun Lee
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.; Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.; Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea
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Milone M, Musella M, Conzo G, Campana G, De Filippo D, Coretti G, Amato M, Salvatore G, Amato B, Milone F. Thyroidectomy in high body mass index patients: A single center experience. Int J Surg 2016; 28 Suppl 1:S38-41. [PMID: 26708851 DOI: 10.1016/j.ijsu.2015.12.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 04/30/2015] [Accepted: 05/15/2015] [Indexed: 10/22/2022]
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Reinisch A, Malkomes P, Liese J, Schreckenbach T, Holzer K, Bechstein WO, Habbe N. Education in thyroid surgery: a matched-pair analysis comparing residents and board-certified surgeons. Langenbecks Arch Surg 2016; 401:239-47. [PMID: 26931517 DOI: 10.1007/s00423-016-1390-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/23/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Resident participation in operative procedures is mandatory in educational residency programs but remains controversial, especially in the context of patient safety. This study compared the surgical quality and outcomes of thyroidectomies performed by surgical residents (RESs) and board-certified surgeons (BCSs). METHODS This retrospective matched-pair study included patients undergoing thyroidectomies for multinodular goiter, Grave's disease and early-stage thyroid cancer that were performed by a RES with BCS supervision between 2006 and 2014. The intraoperative and postoperative course, complication rates and handling of the recurrent laryngeal nerve (RLN) and parathyroid glands were analyzed. RESULTS In total, 112 thyroidectomies that were performed by a RES fulfilled the inclusion criteria and were matched 1:1 with BCS patients. We included 88 hemithyroidectomies, 80 subtotal thyroidectomies and 56 total thyroidectomies. No significant differences in the handling of the RLN or parathyroid glands, the rates of postoperative RLN palsies or the rates of hypocalcaemia were found. No intraoperative complications led to the replacement of the RES as the surgeon-in-charge. Three RES and two BCS patients experienced postoperative haemorrhages (p = 0.205), and three surgical site infections (p = 1.000) occurred in each group. The mean operative time and the length of stay did not differ significantly between the two groups. CONCLUSIONS Major aspects of patient safety in thyroid surgery are not affected by resident participation. Thyroidectomies performed by RES are not significantly longer and reveal no differences in length of stay or complication rates. The economic burden of resident involvement is modest.
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Affiliation(s)
- Alexander Reinisch
- Department of General and Visceral Surgery, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Patrizia Malkomes
- Department of General and Visceral Surgery, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Juliane Liese
- Department of General and Visceral Surgery, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Teresa Schreckenbach
- Department of General and Visceral Surgery, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Katharina Holzer
- Department of General and Visceral Surgery, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Wolf Otto Bechstein
- Department of General and Visceral Surgery, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Nils Habbe
- Department of General and Visceral Surgery, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
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Finel JB, Mucci S, Branger F, Venara A, Lenaoures P, Rodien P, Hamy A. Thyroidectomy in patients with a high BMI: a safe surgery? Eur J Endocrinol 2014; 171:99-105. [PMID: 24913199 DOI: 10.1530/eje-14-0063] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To study and compare the specific postoperative complications of thyroidectomy in a population with a BMI ≥25 with a population having a BMI below 25. DESIGN A prospective study was carried out from September 2010 to January 2013. METHODS Postoperative calcemia, laryngeal mobility, bleeding or infectious complications, postoperative hospital stay, and operation time were studied and compared statistically by a χ(2)-test or Student's t-test. RESULTS A total of 240 patients underwent total thyroidectomy and 126 underwent a partial thyroidectomy. Of them, 168 patients had a BMI below 25 and 198 patients had a BMI ≥25. There was no statistically significant difference in the occurrence of early or permanent hypoparathyroidism, recurrent laryngeal nerve palsy, bleeding complications, or postoperative duration of hospital stay. There was, however, a significant operative time in patients with a BMI ≥25. CONCLUSION Despite the longer operative time, thyroidectomy (total or partial) can be performed safely in patients with a BMI ≥25.
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Affiliation(s)
- J B Finel
- Département De Chirurgie Viscérale et EndocrinienneDépartement D'EndocrinologieCentre Hospitalo-Universitaire, Angers, France
| | - S Mucci
- Département De Chirurgie Viscérale et EndocrinienneDépartement D'EndocrinologieCentre Hospitalo-Universitaire, Angers, France
| | - F Branger
- Département De Chirurgie Viscérale et EndocrinienneDépartement D'EndocrinologieCentre Hospitalo-Universitaire, Angers, France
| | - A Venara
- Département De Chirurgie Viscérale et EndocrinienneDépartement D'EndocrinologieCentre Hospitalo-Universitaire, Angers, France
| | - P Lenaoures
- Département De Chirurgie Viscérale et EndocrinienneDépartement D'EndocrinologieCentre Hospitalo-Universitaire, Angers, France
| | - P Rodien
- Département De Chirurgie Viscérale et EndocrinienneDépartement D'EndocrinologieCentre Hospitalo-Universitaire, Angers, France
| | - A Hamy
- Département De Chirurgie Viscérale et EndocrinienneDépartement D'EndocrinologieCentre Hospitalo-Universitaire, Angers, France
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Abstract
BACKGROUND Obesity is associated with a number of medical comorbidities and is considered a risk factor for surgical complications. However, the impact of obesity on the safety of minimally invasive video-assisted thyroidectomy (MIVAT) has not been well defined. We sought to determine the relationship between obesity and the risk of complications in patients undergoing MIVAT. METHOD A prospectively maintained database of all thyroid surgeries performed from January 2006 through June 2012 was searched and all cases of MIVAT were identified. Patients were stratified into three body mass index (BMI) groups according to the National Institutes of Health classification for obesity: normal (BMI ≤ 24.9 kg/m(2)), overweight (BMI 25-29.9 kg/m(2)) and obese (BMI ≥ 30 kg/m(2)). The total number of complications was compared among the three groups, and MIVAT patients were also compared to a cohort of patients undergoing conventional thyroid surgery. RESULTS There were 233 MIVATs performed on 223 patients. The mean overall BMI for the study population was 25.4 kg/m(2). There were 123 procedures (52.8%) in the normal group, 76 procedures (32.6%) in the overweight group, and 34 procedures (14.6%) in the obese group. Complications included 1 case of cellulitis (0.4%), 6 cases of temporary hypocalcemia (2.6%), and 6 cases of transient vocal fold paresis (2.6%). No patients suffered permanent hypocalcemia or a permanent recurrent laryngeal nerve injury. There were 9 complications in the normal group (7.3%), 4 complications in the overweight group (5.3%), and no complications in the obese group. Due to the low number of complications in this series, the overweight and obese groups were combined into a high BMI group for further analysis. Statistical analysis using simple logistic regression models revealed that there was no significant difference in the number of complications in patients with a high BMI compared with patients with a normal BMI (odds ratio [OR] 0.48 [confidence interval (CI) 0.14-1.63], p=0.2). The MIVAT group had fewer overall complications than the conventional thyroidectomy group. CONCLUSIONS Overweight and obese patients undergoing MIVAT in this series were not at an increased risk for surgical complications. The MIVAT procedure may be considered safe in patients with a high BMI, who may derive particular benefit from a minimally invasive approach.
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Affiliation(s)
- William S. Duke
- Department of Otolaryngology-Head and Neck Surgery, Georgia Regents University, Augusta, Georgia
| | - Jennifer R. White
- Department of Otolaryngology-Head and Neck Surgery, Georgia Regents University, Augusta, Georgia
| | - Jennifer L. Waller
- Department of Biostatistics and Epidemiology, Georgia Regents University, Augusta, Georgia
| | - David J. Terris
- Department of Otolaryngology-Head and Neck Surgery, Georgia Regents University, Augusta, Georgia
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Reoperative parathyroidectomy: who is at risk and what is the risk? J Surg Res 2014; 191:256-61. [PMID: 25012272 DOI: 10.1016/j.jss.2014.05.073] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 05/20/2014] [Accepted: 05/23/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Persistent and recurrent hyperparathyroidism necessitate reoperation, which is associated with increased procedure-specific complication rates. The effect of reoperative parathyroidectomy on more generalized outcomes is poorly understood. We sought to determine patient, provider, and perioperative characteristics associated with reoperation, as well as to determine the associated risks. METHODS All patients receiving a parathyroidectomy in the American College of Surgeons National Surgical Quality Improvement Program database (2008-2011) were identified. Patients receiving initial parathyroidectomy were compared with those receiving reoperative parathyroidectomy. Descriptive statistics and univariate analyses were performed. Multivariate logistic regression models were developed for significant outcome measures. RESULTS Of 9114 parathyroidectomies performed, 8738 (95.9%) were initial and 376 (4.1%) were reoperative. The annual rate of reoperation was 3.6%-4.8%. Patients undergoing reoperative parathyroidectomy were more likely to be obese (48.5 versus 40.0%, P = 0.009) and American Society of Anesthesiologist class 3 (40.7 versus 30.3%, P = 0.001) than patients undergoing initial parathyroidectomy. There was no difference in gender, age, or race. Reoperations had a longer median operative time (101 minimum, interquartile range [IQR] [74-146] versus 76 [55-105], P <0.001) and a longer postoperative length of stay (median days until discharge 1, IQR [1-1] versus 1, IQR [0-1], P <0.001). No difference was found in the rates of mortality and common postoperative morbidity as measured in NSQIP. Patients undergoing reoperation were more likely to be readmitted within 30 d (12.7 versus 2.6%, P <0.001). After adjusting for confounders, reoperation continued to be significantly associated with readmission (odds ratio 3.82, confidence interval: 1.63-8.97; P = 0.002). CONCLUSIONS Obesity and an American Society of Anesthesiologist 3 classification are independently associated with reoperation. Readmission within 30 d is associated with reoperation and is a target for patient education and quality improvement after this procedure.
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Elfenbein DM, Schneider DF, Chen H, Sippel RS. Surgical site infection after thyroidectomy: a rare but significant complication. J Surg Res 2014; 190:170-6. [PMID: 24739508 DOI: 10.1016/j.jss.2014.03.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/06/2014] [Accepted: 03/12/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) after thyroidectomy are rare but can have significant consequences. Thyroidectomy is a clean case, and the patterns for use of prophylactic antibiotics vary. We hypothesized that patient and operative characteristics may predict a higher risk of SSI, and that SSI are associated with other complications leading to increased resource utilization. METHODS Data from the American College of Surgeons National Surgical Quality Improvement Program dataset for patients who underwent thyroidectomy through cervical incisions from 2005-2011 were included. Bivariate analysis using t-tests and chi-square tests were performed, and variables with P<0.2 were considered for inclusion in a multivariate logistic regression model. RESULTS A total of 49,326 patients underwent thyroidectomy from 2005-2011 and 179 (0.36%) had an SSI. On multivariate analysis, the strongest predictors of SSI were operative time (P<0.001) and wound classification clean-contaminated (odds ratio 6.1; 95% confidence interval, 3.6, 10.3). Preoperative factors associated with SSI on multivariate analysis had lower magnitudes of influence on SSI risk but included obesity, alcohol use, and nonindependent functional status. Patients with SSI were more likely to have a wound dehiscence, renal insufficiency, bleeding requiring transfusion, and return to the operating room on a multivariate model of outcomes. CONCLUSIONS Although rare, SSI after thyroidectomy are associated with other postoperative complications. We have identified preoperative and intraoperative factors that are associated with SSI, and this may help identify high-risk patients who may benefit from selective use of antibiotics.
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Affiliation(s)
- Dawn M Elfenbein
- Section of Endocrine Surgery and Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin, Madison, Wisconsin.
| | - David F Schneider
- Section of Endocrine Surgery and Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Herbert Chen
- Section of Endocrine Surgery and Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Rebecca S Sippel
- Section of Endocrine Surgery and Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin, Madison, Wisconsin
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Abraham CR, Ata A, Carsello CB, Chan TL, Stain SC, Beyer TD. A NSQIP risk assessment for thyroid surgery based on comorbidities. J Am Coll Surg 2014; 218:1231-7. [PMID: 24745620 DOI: 10.1016/j.jamcollsurg.2014.01.055] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 01/16/2014] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Thyroid surgery is associated with low mortality and morbidity and often is performed in an ambulatory setting. The majority of patients undergoing thyroidectomy have an uncomplicated outcome, but common comorbidities may increase mortality and morbidity. Due to low complication rates, studies using single surgeon or single institutional data to identify risk factors for adverse outcomes may be limited by inadequate patient volume. STUDY DESIGN This retrospective cohort study used data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). The study group included all thyroidectomy patients over a 6-year period (2005 to 2010). Common patient comorbidities were identified and analyzed using logistic regression. Risk of adverse outcomes was calculated for single and multiple comorbidities. Statistical significance was set at p < 0.05. RESULTS The study group included 38,577 consecutive patients. Thirty-day mortality and postoperative morbidity were 0.06% and 1.49%, respectively. The risk factors independently associated with morbidity included hypertension, diabetes, advanced age greater than 70 years, COPD, dialysis, malignant thyroid disease, and surgical approach (total thyroidectomy). Substernal thyroidectomy, hypertension, diabetes, age greater than 70 years, COPD, and dialysis were significant predictors (unadjusted) of mortality. Multiple comorbidities resulted in significant cumulative risk. The presence of 3 or more comorbidities was associated with a postoperative morbidity of 5.1% (p < 0.001) and mortality as high as 12.5%. CONCLUSIONS Thyroid surgery is generally safe. Common comorbidities significantly increase the risk of adverse outcomes and death. Clinically applicable risk calculation based on overall health may improve patient selection, surgical management, and informed consent.
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Affiliation(s)
| | - Ashar Ata
- Department of Surgery, Albany Medical College, Albany, NY
| | | | - Tiffany L Chan
- Department of Surgery, Albany Medical College, Albany, NY
| | - Steven C Stain
- Department of Surgery, Albany Medical College, Albany, NY
| | - Todd D Beyer
- Department of Surgery, Albany Medical College, Albany, NY
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Shinall MC, Broome JT, Nookala R, Shinall JB, Kiernan C, Parks L, Solórzano CC. Total thyroidectomy for Graves' disease: compliance with American Thyroid Association guidelines may not always be necessary. Surgery 2013; 154:1009-15. [PMID: 24075271 DOI: 10.1016/j.surg.2013.04.064] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 04/26/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Total thyroidectomy (TT) is the preferred operative approach to Graves' disease. Current guidelines of the American Thyroid Association call for the administration of potassium iodide (KI) and achievement of euthyroid state before operation. Small numbers and a mixture of operative approaches spanning several decades hinder previous operative series. We present the outcomes for TT at a single high-volume center. METHODS A retrospective cohort study was conducted on 165 patients undergoing TT for Graves' disease from July 2007 to May 2012. RESULTS Mean age was 43 years (range, 17-78), and 128 patients (78%) were female. A total of 95% of patients were on methimazole or propylthiouracil, and 42% remained hyperthyroid at time of TT. Only 3 (2%) patients received KI. Mean operative time was 132 minutes (range, 59-271). Mean gland size and blood loss were 41 g (range, 8-180) and 55 mL (range, 10-1050), respectively. No patient developed thyroid storm. Median follow-up was 7.5 months. Temporary and permanent hypocalcemia developed in 51 (31%) and 2 patients (1.2%), respectively. Temporary and permanent recurrent laryngeal nerve paresis occurred in 12 (7%) and one (0.6%) patient, respectively. Sixty-one (37%) patients experienced at least one complication. On multivariate analysis, patient age younger than 45 years (odds ratio 2.93, 95% confidence interval 1.39-6.19) and obesity (odds ratio 2.11, 95% confidence interval 1.00-4.43) were associated with the occurrence of complications. CONCLUSION This high-volume surgeon experience demonstrates no appreciable detriment to patient outcomes when recommendations of the American Thyroid Association for routine use of KI and euthyroid state before thyroidectomy are not met. Transient hypocalcemia and hoarseness are frequent complications of TT for Graves' disease, resolving within 6 months in most patients. Age younger than 45 years and obesity are risk factors for postoperative complications.
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Affiliation(s)
- Myrick C Shinall
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Nashville, TN.
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Santini J, Alfonsi JP, Bonichon F, Bozec A, Giovanni A, Goichot B, Heymann MF, Laccourreye O, Latil G, Papon JF, Sadoul JL, Strunski V, Tissier-Rible F. Patient information ahead of thyroid surgery. Guidelines of the French Society of Oto-Rhino-Laryngology and Head and Neck Surgery (SFORL). Eur Ann Otorhinolaryngol Head Neck Dis 2013; 130:363-8. [PMID: 23953935 DOI: 10.1016/j.anorl.2013.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 04/09/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The authors present the guidelines of the French Society of Oto-Rhino-Laryngology and Head and Neck Surgery (SFORL) on patient information ahead of thyroid surgery. METHODS A multidisciplinary medical team was tasked with a scientific literature review on this topic. The texts retrieved were analyzed by an independent committee. A joint meeting drew up the final guidelines. The strength of the recommendations (grade A, B or C) was based on levels of evidence. RESULTS It is recommended that the results of preoperative exploration and the indications for surgery should be explained to the patient. Patients should be informed as to the type of surgery, surgical objectives, risks and consequences. It is mandatory to obtain the patient's written consent before surgery. CONCLUSION Appropriate medical information is a critical step in patient management.
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Affiliation(s)
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- Oto-rhino-laryngologie, institut universitaire de la face et du cou, 31, avenue de Valombrose, 06103 Nice, France
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Abstract
The two most common early complications of thyroid surgery are hypocalcemia (20-30%) and recurrent laryngeal nerve injury (5-11%). Bilateral recurrent nerve paralysis resulting in adduction of the vocal cords is a rare life-threatening complication (occurring in less than 0.1% of cases that requires emergency management. Prevention of complications depends on careful operative technique and is enhanced for some teams by the use of specific techniques such as intraoperative neuromonitoring. Postsurgical hypocalcemia is managed by the administration of calcium plus vitamin D for at least 10 days. Recurrent laryngeal nerve paralysis recovers in most cases, and no invasive therapy should be performed for at least six months, except for emergency presentations; laryngeal surgery techniques may offer significant improvement if phonation or respiratory sequelae persist beyond six months, but the results are inconsistent. There should be a systematic strategy for detection of complications after thyroidectomy involving a multidisciplinary approach.
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Affiliation(s)
- N Christou
- Service de chirurgie digestive, générale et endocrinienne, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
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Abstract
PURPOSE OF REVIEW To review several of the most recent and most important clinical studies regarding the effects of thyroid treatments on weight change, associations between thyroid status and weight, and the effects of obesity and weight change on thyroid function. RECENT FINDINGS Weight decreases following treatment for hypothyroidism. However, following levothyroxine treatment for overt hypothyroidism, weight loss appears to be modest and mediated primarily by loss of water weight rather than fat. There is conflicting evidence about the effects of thyroidectomy on weight. In large population studies, even among euthyroid individuals, serum thyroid-stimulating hormone is typically positively associated with body weight and BMI. Both serum thyroid-stimulating hormone and T3 are typically increased in obese compared with lean individuals, an effect likely mediated, at least in part, by leptin. Finally, there is no consistent evidence that thyroid hormone treatment induces weight loss in obese euthyroid individuals, but thyroid hormone analogues may eventually be useful for weight loss. SUMMARY The interrelationships between body weight and thyroid status are complex.
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Consorti F, Milazzo F, Notarangelo M, Scardella L, Antonaci A. Factors influencing the length of the incision and the operating time for total thyroidectomy. BMC Surg 2012; 12:15. [PMID: 22849398 PMCID: PMC3447649 DOI: 10.1186/1471-2482-12-15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 07/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incision used for thyroid surgery has become shorter over time, from the classical 10 cm long Kocher incision to the shortest 15 mm access achieved with Minimally Invasive Video-Assisted Thyroidectomy. This rather large interval encompasses many different possible technical choices, even if we just consider open surgery.The aim of the study was to assess the correlation between incision length and operation duration with a set of biometric and clinical factors and establish a rationale for the decision on the length of incision in open surgery. METHODS Ninety-seven consecutive patients scheduled for total thyroidectomy were prospectively evaluated. All operations were performed by the same team and the surgeon decided the length of the incision according to his personal judgement. Patients who had previously undergone neck surgery were excluded. RESULTS The length of the incision was strongly correlated with gender, thyroid volume, neck circumference and clinical diagnosis and weakly correlated with the body mass index. Operation duration was only weakly correlated with gender and neck circumference. Multiple linear regression revealed that the set of factors assessed explained almost 60 % of the variance in incision length but only 20 % of the variance in operation duration. When patients were classified according to the distribution of their thyroid volume, cases within one standard deviation of the mean did not show a significant difference in terms of operation duration with incisions of various lengths. CONCLUSIONS Although thyroid volume was a major factor in driving the decision with respect to the length of the incision, our study shows that it had only minor effect on the duration of the operation. Many more open thyroidectomies could therefore be safely performed with shorter incisions, especially in women. Duration of the operation is probably more closely linked to the inherent technical difficulty of each case.
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Affiliation(s)
- Fabrizio Consorti
- Department of Surgical Sciences, University Sapienza of Rome, Rome, Italy.
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