Association between preoperative tracheal deviation and postoperative complications of thyroidectomy for giant...

To evaluate the association between preoperative computed tomography (CT)-measured tracheal deviation and postoperative composite complications after thyroidectomy for giant multinodular goiter.

This retrospective cohort included 90 patients with a CT-measured maximum thyroid diameter ≥10 cm. Tracheal deviation was categorized as ≤5 mm, 6-10 mm, or >10 mm. Thyroid volume was calculated using the ellipsoid formula. Because no composite complications occurred in the ≤10-mm group, Firth bias-reduced logistic regression was performed. An exploratory model was adjusted additionally for age, sex, thyroid volume, gland distribution, thyroid functional status, thyroid autoantibody status, and retrosternal extension.

Composite complications occurred in 16 patients (17.8%), all from the >10-mm group. The median thyroid volume increased significantly across the deviation groups (210.5, 249.0, and 389.2 mL; p<0.001). Univariable Firth analysis showed a strong association between tracheal deviation >10 mm and composite complications (OR 50.90, 95% CI 6.44-6582.01; p<0.001). In the adjusted model, the association remained positive but was not significant (OR 8.91, 95% CI 0.28-1704.62; p=0.224).

Tracheal deviation >10 mm identified patients at high crude risk for postoperative complications, but an independent association beyond thyroid volume, retrosternal extension, and other clinical factors was not demonstrated. Tracheal deviation should be interpreted together with other CT features of giant multinodular goiter.