A prospective analysis of thyroidectomy outcomes in a resource-limited setting

This study aimed to document thyroidectomy outcomes in the surgical endocrine unit, Mulago Hospital, Kampala, Uganda. The burden of global surgical disease is currently receiving much attention, especially in countries experiencing epidemiological transition. There is a paucity of publications on surgical outcomes from Sub-Saharan Africa. International thyroid guidelines from high-income countries do not factor in the logistical challenges or the advanced pathology faced by the surgeon in resource-limited settings.

This was a prospective cohort study in 2013. Eight peri-operative variables of poor outcome were analysed statistically against six outcomes variables. Data was collected from 0 to 6 months post-operatively.

Forty-two thyroidectomies were performed over a 3-month period (female = 38). Intraoperative events recorded included rebleeding = 10 %, infection = 0 %, transient voice symptoms = 30 %, transient hypocalcaemia = 12.5 %, recurrent laryngeal nerve (RLN) paralysis = 7.5 % and permanent hypocalcaemia = 15 %. There was a weak powered association between RLN paralysis and total thyroidectomy and smaller thyroid size. There were associations between large thyroid size and both permanent hypocalcaemia and rebleeding. Younger patients showed statistically more transient voice changes compared to older patients. Older patients were statistically more likely to develop rebleeding. Shorter operative duration was associated with transient voice change, permanent hypocalcaemia and rebleeding. Airway difficulties and transient hypocalcaemia were statistically significant in prolonged procedures.

Whilst the thyroidectomy outcomes are not equal to international standards, an acceptable standard is achievable in this resource-limited setting. Poor outcomes are multifactorial but extremes of thyroid size, extremes of operation duration and total thyroidectomies all have statistically poorer outcomes in this setting.