Background: Although thyroidectomyisoneofthemostcommonsurgicalproceduresperformedworldwide, some permanentcomplications,despitetheconsiderablyreducingincidence,mayaffectdramaticallythepatients quality oflife.Thepurposeofthisstudyistoevaluatewhetherfactorsidentifiedpreoperativelyandexpressedina score couldbepredictorsofmajorsurgicaldifficultyduringtotalthyroidectomyandinfluencetheincidenceof complications. Methods: A totalof164patientswhounderwenttotalthyroidectomywereexamined.Foreachpatientwe calculated apreoperativescore,includingsevenparameters,whichweevaluatedtobepredictorsofdifficultyin thyroid surgery,thatis,sex,bodymassindex(BMI),necklength,neckextension,thyroidglandvolume,thyroiditis, and increasedparenchymalvascularization.Theoverallscorewasalsocomparedwithperi-andpost-operative factors describingobjectivelythedifficultyinthyroidsurgery.Thesefactorsarethedurationoftheoperation,the length ofhospitalization,theincidenceofcomplicationssuchashemorrhage,hypoparathyroidism,andrecurrent laryngeal nerveinjuries. Results: Therewasnostatisticallysignificantassociationbetweenourscoreandeitherthepercentageof postoperativecomplicationsorthelengthofhospitalization.Theoperativetimewastheonlyvariableremarkably associatedwiththescorevalue(p < 0.00001).Comparingthedurationoftheoperationwitheachofthepreoperative predictivefactors,wefoundthatnoneofthefactorsreachedthevalueofstatisticalsignificance,butacloseassociation couldbenotedwiththethyroidvolumeandtheBMI. Conclusions: In ourstudy,predictorsofdifficultyinthyroidectomydidnotaffectmorbidityrates,assuggestedby previousstudies,butonlyoperativetimes,whichweresignificantlyincreasedinpatientswithhigherscore.Although ourresultshavelimitedstatisticalsignificance,theyallowustoconfirmthefundamentalroleofasystematicuseof opticalmagnificationandmicrosurgicaltechniqueinthyroidectomy.Furtherstudies,withalargercohortofpatients, areneededtovalidateourresultsandtoformulateauniversallyacceptedpredictivescoreofdifficultyin thyroidectomypreoperatively.

May predictors of difficulty in thyroid surgery increase the incidence of complications? Prospective study with the proposal of a preoperative score / D'Orazi, Valerio; Sacconi, Andrea; Trombetta, Silvia; Karpathiotakis, Menelaos; Pichelli, Daniele; Di Lorenzo, Enrico; Ortensi, Alice; Urciuoli, Paolo; Biffoni, Marco; Ortensi, Andrea. - In: BMC SURGERY. - ISSN 1471-2482. - 18:Suppl 1(2019). [10.1186/s12893-018-0447-7]

May predictors of difficulty in thyroid surgery increase the incidence of complications? Prospective study with the proposal of a preoperative score

D'Orazi, Valerio
;
Trombetta, Silvia;Karpathiotakis, Menelaos;Pichelli, Daniele;Di Lorenzo, Enrico;Urciuoli, Paolo;Biffoni, Marco;Ortensi, Andrea
2019

Abstract

Background: Although thyroidectomyisoneofthemostcommonsurgicalproceduresperformedworldwide, some permanentcomplications,despitetheconsiderablyreducingincidence,mayaffectdramaticallythepatients quality oflife.Thepurposeofthisstudyistoevaluatewhetherfactorsidentifiedpreoperativelyandexpressedina score couldbepredictorsofmajorsurgicaldifficultyduringtotalthyroidectomyandinfluencetheincidenceof complications. Methods: A totalof164patientswhounderwenttotalthyroidectomywereexamined.Foreachpatientwe calculated apreoperativescore,includingsevenparameters,whichweevaluatedtobepredictorsofdifficultyin thyroid surgery,thatis,sex,bodymassindex(BMI),necklength,neckextension,thyroidglandvolume,thyroiditis, and increasedparenchymalvascularization.Theoverallscorewasalsocomparedwithperi-andpost-operative factors describingobjectivelythedifficultyinthyroidsurgery.Thesefactorsarethedurationoftheoperation,the length ofhospitalization,theincidenceofcomplicationssuchashemorrhage,hypoparathyroidism,andrecurrent laryngeal nerveinjuries. Results: Therewasnostatisticallysignificantassociationbetweenourscoreandeitherthepercentageof postoperativecomplicationsorthelengthofhospitalization.Theoperativetimewastheonlyvariableremarkably associatedwiththescorevalue(p < 0.00001).Comparingthedurationoftheoperationwitheachofthepreoperative predictivefactors,wefoundthatnoneofthefactorsreachedthevalueofstatisticalsignificance,butacloseassociation couldbenotedwiththethyroidvolumeandtheBMI. Conclusions: In ourstudy,predictorsofdifficultyinthyroidectomydidnotaffectmorbidityrates,assuggestedby previousstudies,butonlyoperativetimes,whichweresignificantlyincreasedinpatientswithhigherscore.Although ourresultshavelimitedstatisticalsignificance,theyallowustoconfirmthefundamentalroleofasystematicuseof opticalmagnificationandmicrosurgicaltechniqueinthyroidectomy.Furtherstudies,withalargercohortofpatients, areneededtovalidateourresultsandtoformulateauniversallyacceptedpredictivescoreofdifficultyin thyroidectomypreoperatively.
Difficult thyroidectomy; Predictive factors; Preoperative difficulty score; Thyroid surgery
01 Pubblicazione su rivista::01a Articolo in rivista
May predictors of difficulty in thyroid surgery increase the incidence of complications? Prospective study with the proposal of a preoperative score / D'Orazi, Valerio; Sacconi, Andrea; Trombetta, Silvia; Karpathiotakis, Menelaos; Pichelli, Daniele; Di Lorenzo, Enrico; Ortensi, Alice; Urciuoli, Paolo; Biffoni, Marco; Ortensi, Andrea. - In: BMC SURGERY. - ISSN 1471-2482. - 18:Suppl 1(2019). [10.1186/s12893-018-0447-7]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1278344
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