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Outcomes in Pediatric Thyroidectomy: Results From a Multinational, Multi-institutional Database.

Matthew Maksimoski¹, Andrew J Bauer², Ken Kazahaya³

¹Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery

|February 8, 2022

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Summary

This study found that lower hospital volume and concurrent hypoparathyroidism are linked to recurrent laryngeal nerve (RLN) injury in pediatric thyroidectomy. Complication rates remain low, supporting the safety of this procedure in specialized centers.

Area of Science:

Pediatric Surgery
Endocrine Surgery
Otolaryngology

Background:

Traditional data extraction for thyroidectomy from billing databases may miss crucial information.
A multi-institutional pediatric thyroidectomy database was established to capture comprehensive data.
Evaluating recurrent laryngeal nerve (RLN) injury and hypoparathyroidism is critical for surgical outcomes.

Purpose of the Study:

To utilize a multi-institutional pediatric thyroidectomy database to assess the incidence and risk factors for RLN injury and hypoparathyroidism.
To identify factors associated with these complications in pediatric thyroidectomy patients.
To provide data for preoperative risk assessment and surgical planning.

Main Methods:

Retrospective multi-institutional cohort study involving 1025 thyroidectomies from 10 North American pediatric hospital systems.

Keywords:

big data evidence-based medicine hypoparathyroidism outcomes research patient safety recurrent laryngeal nerve injury

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Data were collected centrally and analyzed using univariate and multivariable regression models.

Patient demographics, pathologies, surgical procedures, and outcomes (RLN injury, hypoparathyroidism) were examined.

Main Results:

The study included 1025 pediatric thyroidectomies; common pathologies included papillary thyroid carcinoma, Graves' disease, and follicular adenoma.
Overall complication rates were low: 1.1% RLN injury (0.8% permanent) and 7.2% hypoparathyroidism (3.3% permanent).
Multivariable analysis identified lower institutional volume and concurrent hypoparathyroidism as predictors of RLN injury. Surgical indication, central neck dissection, and extent of surgery correlated with hypoparathyroidism.

Conclusions:

Thyroidectomy in pediatric tertiary care centers demonstrates low complication rates, supporting its safety.
Institutional volume and hypoparathyroidism are associated with RLN injury.
Factors such as surgical indication, central neck dissection, and extent of surgery are linked to hypoparathyroidism, informing risk assessment.