Top

Patient Safety in Surgery

Published in:

Open Access 01-12-2014 | Research

Prolonged duration of surgery is not a risk factor for postoperative complications in patients undergoing total thyroidectomy: a single center experience in 305 patients

Authors: Peter C Ambe, Silvia Brömling, Wolfram T Knoefel, Alexander Rehders

Published in: Patient Safety in Surgery | Issue 1/2014

Abstract

Background

Hypocalcemia and nerve injury are the most severe complications after thyroid surgery. The duration of surgery has not been previously considered as a risk factor for postoperative complications in patients undergoing total thyroidectomy. We sort to investigate the influence of prolonged surgery on postoperative complications in patients undergoing total thyroidectomy.

Methods

We hypothesized that a threshold of > 120 minutes of surgical time could represent a surrogate marker for postoperative complications in patients undergoing total thyroidectomy for benign thyroid disorders. The study population was divided into two groups based on the median duration of surgery (120 min): group I ≤ 120 minutes (control group), group II > 120 minutes (study group). The charts of eligible patients undergoing total thyroidectomy within a six-year period from January 1^st 2006 to December 31^st 2012 were reviewed. The primary outcomes included the rates postoperative hypocalcemia and recurrent laryngeal nerve palsy. The secondary outcomes included the rates of postoperative hemorrhage, wound dehiscence and length of hospital stay.

Results

305 cases of thyroidectomy were included for analysis; 130 (42.6%) control group and 175 (57.4%) study group. Transient (15.4% vs 19.4%) and permanent (3.8% vs. 2.9%) hypocalcemia were recorded in control and study group respectively. The incidence of nerve palsy was 1.5% in the control group and 1.4% in the study group. The mean length of postoperative hospital stay was 3d in both groups. There was no significant difference amongst both groups with regard to postoperative bleeding (p = 0.57) and wound dehiscence (p = 0.31). Prolonged surgery (> 120 min) was not identified as a risk factor for increased postoperative complication.

Conclusion

Prolonged duration of surgery > 120 minutes is not a surrogate marker for postoperative complications in patients undergoing total thyroidectomy.

Available only for authorised users

Abboud B, Sargi Z, Akkam M, Sleilaty F: Risk factors for postthyroidectomy hypocalcemia. J Am Coll Surg. 2002, 195: 456-461. 10.1016/S1072-7515(02)01310-8.CrossRefPubMed

Bourrel C, Uzzan B, Tison P, Despreaux G, Frachet B, Modigliani E, Perret GY: Transient hypocalcemia after thyroidectomy. Ann Otol Rhinol Laryngol. 1993, 102: 496-501. 10.1177/000348949310200702.CrossRefPubMed

Coudray C, Lienhardt PY, Conradi A, Seghir A, Dero M, Beurier C, Legendre C: Hypoparathyroidism after thyroid surgery. Ann Otolaryngol Chir Cervicofac. 1994, 111: 189-195.PubMed

Demeester-Mirkine N, Hooghe L, Van Geertruyden J, De Maertelaer V: Hypocalcemia after thyroidectomy. Arch Surg. 1992, 127: 854-858. 10.1001/archsurg.1992.01420070118021.CrossRefPubMed

Hughes OR, Scott-Coombes DM: Hypocalcemia following thyroidectomy for treatment of Graves’ disease: implications for patient management and cost-effectiveness. J Laryngol Otol. 2011, 125: 849-852. 10.1017/S0022215111001332.CrossRefPubMed

McHenry CR, Speroff T, Wentworth D, Murphy T: Risk factors for postthyroidectomy hypocalcemia. Surgery. 1994, 116: 641-647. discussion 647–648PubMed

Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL, Racadot A, Proye C: Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg. 1998, 22: 718-724. 10.1007/s002689900459.CrossRefPubMed

Tredici P, Grosso E, Gibelli B, Massaro MA, Arrigoni C, Tradati N: Identification of patients at high risk for hypocalcemia after total thyroidectomy. Acta Otorhinolaryngol Ital. 2011, 31: 144-148.PubMedCentralPubMed

Wingert DJ, Friesen SR, Iliopoulos JI, Pierce GE, Thomas JH, Hermreck AS: Post-thyroidectomy hypocalcemia. Incidence and risk factors. Am J Surg. 1986, 152: 606-610. 10.1016/0002-9610(86)90435-6.CrossRefPubMed

10.

Al-Azem H, Khan AA: Hypoparathyroidism. Best Pract Res Clin Endocrinol Metab. 2012, 26: 517-522. 10.1016/j.beem.2012.01.004.CrossRefPubMed

11.

De Sanctis V, Soliman A, Fiscina B: Hypoparathyroidism: from diagnosis to treatment. Curr Opin Endocrinol Diabetes Obes. 2012, 19: 435-442. 10.1097/MED.0b013e3283591502.CrossRefPubMed

12.

Chaudhary IA, Afridi Z, Samiullah ᅟ, Masood R, Mallhi AA: To ligate or not the inferior thyroid artery to avoid hypocalcemia after thyroid surgery. J Ayub Med Coll Abbottabad. 2007, 19: 19-22.PubMed

13.

Lang BH, Yih PC, Lo CY: A review of risk factors and timing for postoperative hematoma after thyroidectomy: is outpatient thyroidectomy really safe?. World J Surg. 2012, 36: 2497-2502. 10.1007/s00268-012-1682-1.PubMedCentralCrossRefPubMed

14.

Nobori M, Saiki S, Tanaka N, Harihara Y, Shindo S, Fujimoto Y: Blood supply of the parathyroid gland from the superior thyroid artery. Surgery. 1994, 115: 417-423.PubMed

15.

Sands NB, Payne RJ, Cote V, Hier MP, Black MJ, Tamilia M: Female gender as a risk factor for transient post-thyroidectomy hypocalcemia. Otolaryngol Head Neck Surg. 2011, 145: 561-564. 10.1177/0194599811414511.CrossRefPubMed

16.

Dralle H, Sekulla C, Haerting J, Haerting J, Timmermann W, Neumann HJ, Kruse E, Grond S, Mühlig HP, Richter C, Voss J, Thomusch O, Lippert H, Gastinger I, Brauckhoff M, Gimm O: Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery. 2004, 136: 1310-1322. 10.1016/j.surg.2004.07.018.CrossRefPubMed

17.

Chan WF, Lang BH, Lo CY: The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: a comparative study on 1000 nerves at risk. Surgery. 2006, 140: 866-872. 10.1016/j.surg.2006.07.017. discussion 872–863CrossRefPubMed

18.

Steurer M, Passler C, Denk DM, Schneider B, Niederle B, Bingenzahn W: Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk. Laryngoscope. 2002, 112: 124-133. 10.1097/00005537-200201000-00022.CrossRefPubMed

19.

Hermann M, Alk G, Roka R, Glaser K, Freissmuth M: Laryngeal recurrent nerve injury in surgery for benign thyroid diseases: effect of nerve dissection and impact of individual surgeon in more than 27,000 nerves at risk. Ann Surg. 2002, 235: 261-268. 10.1097/00000658-200202000-00015.PubMedCentralCrossRefPubMed

20.

Barczynski M, Konturek A, Cichon S: Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg. 2009, 96: 240-246. 10.1002/bjs.6417.CrossRefPubMed

21.

Thomusch O, Sekulla C, Walls G, Machens A, Dralle H: Intraoperative neuromonitoring of surgery for benign goiter. Am J Surg. 2002, 183: 673-678. 10.1016/S0002-9610(02)00856-5.CrossRefPubMed

22.

Dralle H: Pichlamayr R [Decrease of risks in reoperation for benign struma]. Chirurg. 1991, 62: 169-175.PubMed

23.

Levin KE, Clark AH, Duh QY, Demeure M, Siperstein AE, Clark OH: Reoperative thyroid surgery. Surgery. 1992, 111: 604-609.PubMed

24.

Seiler CA, Glaser C, Wagner HE: Thyroid gland surgery in an endemic region. World J Surg. 1996, 20: 593-596. 10.1007/s002689900092. discussion 596–597CrossRefPubMed

25.

Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I, Dralle H: Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg. 2000, 24: 1335-1341. 10.1007/s002680010221.CrossRefPubMed

26.

Mehanna HM, Jain A, Randeva H, Watkinson J, Shaha A: Postoperative hypocalcemia–the difference a definition makes. Head Neck. 2010, 32: 279-283.PubMed

27.

Pfleiderer AG, Ahmad N, Draper MR, Vrotsou K, Smith WK: The timing of calcium measurements in helping to predict temporary and permanent hypocalcemia in patients having completion and total thyroidectomies. Ann R Coll Surg Engl. 2009, 91: 140-146. 10.1308/003588409X359349.PubMedCentralCrossRefPubMed

28.

Ambe P, Lindecke K, Knoefel WT, Rehders A: Cervical compression due to benign thyroid disorders is not associated with increased postoperative morbidity. Eur Arch Otorhinolaryngol. 2014. doi:10.1007/s00405-014-3193-1

29.

Cavicchi O, Piccin O, Caliceti U, De Cataldis A, Pasquali R, Ceroni AR: Transient hypoparathyroidism following thyroidectomy: a prospective study and multivariate analysis of 604 consecutive patients. Otolaryngol Head Neck Surg. 2007, 137 (4): 654-658. 10.1016/j.otohns.2007.03.001.CrossRefPubMed

Title: Prolonged duration of surgery is not a risk factor for postoperative complications in patients undergoing total thyroidectomy: a single center experience in 305 patients
Authors: Peter C Ambe
Silvia Brömling
Wolfram T Knoefel
Alexander Rehders
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Patient Safety in Surgery / Issue 1/2014
Electronic ISSN: 1754-9493
DOI: https://doi.org/10.1186/s13037-014-0045-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prolonged duration of surgery is not a risk factor for postoperative complications in patients undergoing total thyroidectomy: a single center experience in 305 patients

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2014

Patient safety – perspectives on evidence, information, and knowledge transfer

The 'Ziran' wrap: reconstruction of critical-sized long bone defects using a fascial autograft and reamer-irrigator-aspirator autograft

Current challenges and future perspectives for patient safety in surgery

MR-compatible antibiotic interlocked nail fabrication for the management of long bone infections: first case report of a new technique

Applicability of the Clavien-Dindo classification to emergency surgical procedures: a retrospective cohort study on 444 consecutive patients

Description of a multidisciplinary initiative to improve SCIP measures related to pre-operative antibiotic prophylaxis compliance: a single-center success story