Clinical impact of obesity on thyroidectomy outcomes: A systematic review and meta-analysis

The global prevalence of obesity is on the rise, and evaluating the interplay between obesity and outcomes in thyroid surgery is increasingly important. This meta-analysis aims to investigate the safety of thyroidectomy in patients with obesity.

PubMed, Ovid Embase, Cochrane Library, CINAHL, Scopus, and Web of Science were searched from its inception to February 2025 by independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The review was registered prospectively on the PROSPERO database (CRD42025630687).

Ten studies, including 108,153 patients, met eligibility criteria, with 23,754 (22%) classified as having obesity. Patients with obesity had greater risks of experiencing recurrent laryngeal nerve injury (odds ratio, 1.15; 95% confidence interval, 1.04-1.28, I² = 7%), hematoma (odds ratio, 1.18; 95% confidence interval, 1.02-1.36, I² = 0%), and wound complications (odds ratio, 1.76; 95% confidence interval, 1.19-2.60, I² = 0%) compared with patients without obesity. Conversely, patients with obesity had lower rates of hypoparathyroidism (odds ratio, 0.79; 95% confidence interval, 0.71-0.88, I² = 0%). However, no difference was observed between groups regarding operative time (mean difference, 3.5 minutes; 95% confidence interval, -1.6, 8.7, I² = 95%) and length of hospital stay (mean difference, 0.3 days; 95% confidence interval, -0.2, 0.7, I² = 100%).

Despite having a lower risk of developing hypoparathyroidism, patients with obesity demonstrated increased risk for hematoma, recurrent laryngeal nerve injury, and wound complications. Nonetheless, further research exploring more stratified body mass index ranges and strategies to mitigate thyroidectomy complications is needed to ascertain the safety of patients with obesity undergoing thyroidectomy.