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Discrepancies in Thyroidectomy Outcomes Between General Surgeons and Otolaryngologists
Stephen Stopenski1, Areg Grigorian1, Rachel Roditi2
1Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Irvine Medical Center, University of California, 333 The City Blvd West, Suite 1600, Orange, CA 92868 USA.
Summary
General surgeons performing thyroidectomies have a higher risk of recurrent laryngeal nerve (RLN) injury and hypocalcemia compared to otolaryngologists. This finding suggests a need for further investigation into surgical training and techniques for thyroidectomy.
Area of Science:
- Surgical Outcomes
- Endocrine Surgery
- Comparative Effectiveness
Background:
- Thyroidectomy is a common procedure performed by both general surgeons and otolaryngologists.
- Limited research exists comparing complication rates between these surgical specialties.
- Postoperative complications such as recurrent laryngeal nerve (RLN) injury, hypocalcemia, and hematoma are key concerns.
Purpose of the Study:
- To compare the incidence of postoperative complications after thyroidectomy between general surgeons and otolaryngologists.
- To identify risk factors associated with RLN injury, hematoma, and hypocalcemia based on surgical specialty.
- To investigate potential disparities in complication rates between the two surgical groups.
Main Methods:
- Utilized the 2016-2017 National Surgical Quality Improvement Program Targeted Thyroidectomy database.
- Compared thyroidectomies performed by general surgeons versus otolaryngologists for benign and malignant thyroid diseases.
- Employed multivariate logistic regression to analyze risk factors for specific complications.
Main Results:
- General surgeons performed 54.4% of the 11,595 thyroidectomies, while otolaryngologists performed 45.6%.
- General surgeons showed increased risk for RLN injury (OR=1.26) and postoperative hypocalcemia (OR=1.17) after controlling for covariates.
- Differences in device utilization (energy sealant, RLN monitoring, drain placement) were noted between specialties.
Conclusions:
- Thyroidectomy performed by general surgeons is associated with a higher risk of RLN injury and postoperative hypocalcemia.
- Discrepancies may be attributed to variations in training, fellowship completion, or surgical volume, warranting further attention.
- The study highlights a need to address potential differences in surgical outcomes for thyroidectomy based on specialty.
