Substernal thyroidectomy is associated with increased morbidity and mortality as compared with conventional cervical...

Area of Science:

• Surgery
• Endocrinology
• Public Health

Background:

• Previous studies on substernal thyroidectomy reported low complication rates.
• A direct comparison between substernal and cervical thyroidectomy outcomes was lacking.
• This study hypothesized higher morbidity and mortality for substernal thyroidectomy.

Purpose of the Study:

• To compare postoperative outcomes between substernal and cervical thyroidectomy.
• To identify specific complications and mortality risks associated with substernal thyroidectomy.
• To analyze a large patient cohort for surgical outcomes.

Main Methods:

• Utilized the New York State Statewide Planning and Research Cooperative System database (1998-2004).
• Identified 33,930 thyroidectomy patients, with 1,153 undergoing substernal procedures.
• Employed multiple logistic regression to analyze substernal thyroidectomy's impact on outcomes, controlling for covariates.

Main Results:

• Substernal thyroidectomy patients were older, had more comorbidities, and were less likely to have malignancy or high-volume center care.
• Substernal thyroidectomy was associated with increased recurrent laryngeal nerve injury, bleeding, deep venous thrombosis, and respiratory failure.
• Mortality risk was over eightfold higher, and length of stay significantly increased for substernal thyroidectomy patients.

Conclusions:

• Substernal thyroidectomy is associated with substantially increased postoperative complications.
• The procedure carries a markedly higher likelihood of mortality compared to cervical thyroidectomy.
• These findings underscore the elevated risks of substernal thyroid surgery.