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Higher Complication Rates for Total versus Partial Thyroidectomy in the Pediatric Population
Brent A Willobee1, Carlos T Huerta1, Hallie J Quiroz1
1DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida; University of Miami Miller School of Medicine, Miami, Florida.
Insights
Total thyroidectomy in children is linked to higher complication rates, including hypocalcemia and nerve injury, compared to partial thyroidectomy. Surgeons should weigh these risks when deciding on the best surgical approach for pediatric patients.
Area of Science:
- Pediatric Surgery
- Endocrine Surgery
- Otolaryngology
Background:
- Thyroidectomy is a common procedure in pediatric patients.
- Understanding complication rates for total versus partial thyroidectomy is crucial for optimal patient care.
- Previous studies have not comprehensively compared these outcomes in a large pediatric cohort.
Purpose of the Study:
- To compare the complication rates and outcomes of total thyroidectomy versus partial thyroidectomy in the pediatric population.
- To identify specific risks associated with each surgical approach.
- To provide evidence-based guidance for surgeons performing pediatric thyroidectomies.
Main Methods:
- Analysis of the Kids' Inpatient Database (KID) from 1997-2012.
- Inclusion of all pediatric cases undergoing total (n=3253) or partial (n=2380) thyroidectomy.
- Utilized propensity score matching to compare outcomes based on surgical complications.
Main Results:
- The study cohort had a median age of 16 years, with 79% females.
- Malignancy (46%) and goiter (42%) were primary indications for surgery.
- Total thyroidectomy was associated with significantly higher rates of postoperative complications, including hypocalcemia (9%) and nerve injury (3%), and a longer median hospital stay compared to partial thyroidectomy.
Conclusions:
- This study represents the largest analysis to date comparing total versus partial thyroidectomy outcomes in children.
- Increased rates of hypocalcemia and nerve injury complications are associated with total thyroidectomy.
- Surgeons must consider these elevated risks when selecting between total and partial thyroidectomy for pediatric patients.
Introduction:
This study aims to analyze the relative risks for total thyroidectomies by comparing complication rates for total versus partial thyroidectomy in the pediatric population.
Methods:
We queried the Kids' Inpatient Database (KID) 1997-2012 for all cases of total (n = 3253) or partial (n = 2380) thyroidectomy. We then designed a propensity score matching model and compared total versus partial thyroidectomy based on surgical complications and outcomes.
Results:
In our cohort, the median age was 16 years and 79% were females. Those treated at a specialty pediatric hospital or pediatric unit in a general hospital comprised 73% of all patients. The most common indications for surgery were malignancy (46%) and goiter (42%). The most common complications were hypocalcemia and nerve injury with an unweighted incidence of 9% (n = 174) and 3% (n = 57) respectively. When compared to partial thyroidectomy, total thyroidectomy was associated with increased rates of postoperative complications. Additionally, the median length of stay was significantly higher for total thyroidectomy patients.
Conclusions:
This is the largest analysis to date comparing outcomes for total versus partial thyroidectomy in the pediatric population. Surgeons should consider the increased rates of hypocalcemia and nerve injury complications when selecting total compared to partial thyroidectomy in children.
