Impact of BMI on perioperative outcomes following total thyroidectomy: a systematic review and meta-analysis

The influence of body mass index (BMI) on perioperative outcomes following total thyroidectomy (TT) remains controversial. We performed a systematic review and meta-analysis to evaluate the association between BMI and perioperative complications after TT.

Twelve observational studies including 22,145 patients undergoing elective TT were analyzed. BMI was categorized per WHO criteria. Primary outcomes were recurrent laryngeal nerve (RLN) palsy and hypoparathyroidism. Secondary outcomes included operative time, length of stay (LOS), postoperative bleeding, and surgical site infection (SSI). Random-effects models were used.

BMI was not associated with RLN palsy. Lower BMI was associated with higher rates of postoperative and transient hypoparathyroidism, while permanent hypoparathyroidism did not differ. Higher BMI was associated with longer operative time and increased postoperative bleeding. LOS and SSI were comparable between groups.

Total thyroidectomy appears to be safe in patients with elevated BMI, as no significant association was observed between BMI and the predefined primary outcomes of recurrent laryngeal nerve palsy or permanent hypoparathyroidism. Interestingly, patients with lower BMI experienced higher rates of postoperative and transient hypoparathyroidism. Higher BMI was associated with longer operative time and may be associated with an increased risk of postoperative bleeding. Therefore, particular attention should be paid to meticulous intraoperative hemostasis in patients with elevated BMI.