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Medical and Surgical Risks in Thyroid Surgery: Lessons from the NSQIP

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

To assess whether perioperative surgical outcomes associated with thyroid operations were different in those with benign or malignant conditions, we queried the NSQIP, a multi-institutional, risk-adjusted, prospective U.S. database.

Methods

A total of 10,838 patients who underwent initial thyroid surgery as their principal operation during 2005–2007 were analyzed. Analysis focused on demographics, preoperative risk factors, operative details, postoperative complications, return to the operating room, and length of surgical stay.

Results

Thirty-three percent of patients had a postoperative diagnosis of malignancy. Mean operating time was 121.8 min (119.3 min benign, 123.0 min malignant, P = .004) and average length of stay 1.16 days (1.12 days benign, vs. 1.21 days malignant, P = .007). Overall morbidity (return to the operating room plus medical complications) was 3.8% for the entire cohort, significantly higher in patients with malignant disease (4.9 vs. 3.3%, respectively, P < .001). On multivariate analysis, American Society of Anesthesiologists class, congestive heart failure (odds ratio [OR] 6.83, 95% confidence interval [CI] 1.81–25.80), dyspnea, and return to the operating room (OR 5.41, 95% CI 3.1–9.45) were significant risk factors for complications, while malignant disease (OR 2.25, 95% CI 1.75–2.9), outpatient status (OR 3.16, 95% CI 2.4–4.17), and other complications (OR 6.46, 95% CI 3.61–11.54) were risk factors for returning to the operating room.

Conclusions

Patients undergoing thyroid surgery for malignancy have a longer length of stay (1.21 days), longer operation times, and return to the operating room at higher rates compared to those with benign disease. Malignancy itself is only an independent risk factor for return to the operating room and not other complications; surgeons may consider keeping those patients overnight for observation.

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Acknowledgment

American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the American College of Surgeons’ NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Authors and Affiliations

  1. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Melanie Goldfarb MD

  2. Division of Breast, Endocrine, and Soft Tissue Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Melanie Goldfarb MD

  3. Department of Endocrine Surgery, Thyroid Cancer Research Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Richard A. Hodin MD & Sareh Parangi MD

  4. Surgical Research Lab, Tufts Medical Center, Boston, MA, USA

    Zvi Perry MD, MPH

Authors
  1. Melanie Goldfarb MD
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  2. Zvi Perry MD, MPH
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  3. Richard A. Hodin MD
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  4. Sareh Parangi MD
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Correspondence to Melanie Goldfarb MD.

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Goldfarb, M., Perry, Z., A. Hodin, R. et al. Medical and Surgical Risks in Thyroid Surgery: Lessons from the NSQIP. Ann Surg Oncol 18, 3551–3558 (2011). https://doi.org/10.1245/s10434-011-1938-2

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  • DOI: https://doi.org/10.1245/s10434-011-1938-2

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