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Experience in a specialist thyroid surgery unit: a demographic study, surgical complications, and outcome
N N al-Suliman1, N F Ryttov, N Qvist
1Department of Surgery, Odense University Hospital, Denmark.
Objective:
To present a demographic study of thyroid diseases and thyroid surgical activity, to analyse the results of one department that has specialised in thyroid surgery during an 11-year period, and to try to define those groups of patients at increased risk of complications and untoward sequelae.
Design:
Retrospective study.
Setting:
Danish regional university hospital.
Subjects:
The total series comprised 1099 consecutive patients who were operated on for benign goitre during an 11-year period. The demographic series comprised a subgroup of 933 patients with goitres from the defined catchment area composed of five municipalities.
Main Outcome Measures:
Annual number of operations for goitre, waiting time to operation, incidence of complications, and sequelae.
Results:
In the demographic study the number of patients operated on for benign thyroid diseases declined from about 50 cases to about 25 cases/100000 inhabitants during the study period. At the same time the average waiting time between consultation and operation increased from 5-33 weeks. In the total series (n = 1099) 18 patients developed temporary unilateral vocal cord paralysis (2%), and 8 developed permanent paralysis (0.7%). There were no bilateral vocal cord paralyses, 7 patients developed temporary postoperative hypocalcaemia (0.6%), and an additional 8 patients (0.7%) developed permanent hypocalcaemia. 5 patients developed wound haematomas (0.5%), and 3 had wound infections (0.3%). A total of 16 patients (1.5%) had a permanent complication in the form of nerve injury or damage to the parathyroid glands. The rates of postoperative complications were significantly higher among patients who had two or more operations on the neck (p = 0.0004), intrathoracic goitres (p = 0.0002), large goitres (p = 0.0002), and those having emergency operations (p = 0.0091).
Conclusion:
The decline in the number of operations for benign goitre at Odense University Hospital parallels the increase it waiting time before operation. This can be explained by loss of operating room capacity rather than introduction of some alternative cure for goitre or change of criteria for operation. Certain groups of patients are at higher risk of complications than others.