Reoperative Thyroid Procedures: Do They Pose a Higher Risk of Complications Compared to First-Time Surgery?

The outcomes of reoperative thyroid procedures are not well documented. We utilized the Collaborative Endocrine Surgery Quality Improvement Program to evaluate the outcomes and complications of reoperative thyroid surgery.

We identified patients undergoing thyroidectomy or thyroid-related procedure (central neck dissection, selective lateral neck dissection, and resection of recurrent disease) utilizing the Collaborative Endocrine Surgery Quality Improvement Program database (2013-2023). Outcomes were compared between patients undergoing first-time total thyroidectomy with central neck dissection and those undergoing resection for recurrent thyroid disease in the central compartment. In addition, we analyzed outcomes of first-time versus reoperative lateral neck dissection for thyroid cancer.

We compared the outcomes of 3617 patients who underwent first-time total thyroidectomy with central neck dissection and 1644 who underwent reoperative central neck surgery. There was no difference in the rate of hematoma or vocal cord dysfunction between the two. However, rates of both short- and long-term hypoparathyroidism were significantly higher in patients undergoing first-time total thyroidectomy with central neck dissection. Short-term hypoparathyroidism occurred in 9% of first-time cases compared to 2% of reoperative cases, and long-term hypoparathyroidism occurred in 4% versus 2%, respectively (both P < 0.05). Among 640 patients who underwent selective lateral neck dissection (533 first-time, 107 reoperative), the rates of hematoma and vocal cord dysfunction were not different between the two groups.

Reoperative thyroid surgery can yield outcomes comparable to first-time procedures when performed at high-volume centers. However, total thyroidectomy with central neck dissection is associated with a higher risk of short- and long-term hypoparathyroidism compared to reoperative central neck surgery.