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Erschienen in: European Archives of Oto-Rhino-Laryngology 8/2014

01.08.2014 | Head and Neck

Risk factors for recurrent nerve palsy after thyroid surgery: a national study of patients treated at Danish departments of ENT Head and Neck Surgery

verfasst von: Christian Godballe, Anders Rørbæk Madsen, Christian Hjort Sørensen, Sten Schytte, Waldemar Trolle, Jens Helweg-Larsen, Lisa Barfoed, Larry Kristiansen, Vibeke Zederkof Sørensen, Grethe Samuelsen, Henrik Baymler Pedersen

Erschienen in: European Archives of Oto-Rhino-Laryngology | Ausgabe 8/2014

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Abstract

Recurrent laryngeal nerve (RLN) injury is a well-known and serious complication to thyroid surgery. The objective was to estimate the frequency of post-thyroidectomy RLN palsy and to identify possible risk factors. Based on the Danish national thyroid surgery database, 6,859 patients treated with thyroid surgery from 1 January 2001 to the 31 December 2008 at the Danish departments of ENT-HNS were analyzed. Unilateral RLN palsy was found in 2.1 % and bilateral in 0.1 %. In benign histology, RLN palsies were registered in 1.3 %. Malignant histology and accordingly neck dissection were the most predominant risk factors with a relative risk (RR) of 5.4 and 5.8, respectively. In benign cases previous performed thyroid surgery had a RR of 10.4. High volume departments with more than 150 thyroid procedures per year seem to perform significantly better. Malignant histology, neck dissection and previous performed thyroid surgery are the strongest predictors for RLN palsy and patient information should be given accordingly. Incomplete resections should be reserved for isthmectomy only. Centralization of thyroid surgery in larger units might improve quality.
Literatur
2.
Zurück zum Zitat Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R (1998) The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 228(3):320–330PubMedCentralPubMedCrossRef Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R (1998) The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 228(3):320–330PubMedCentralPubMedCrossRef
3.
Zurück zum Zitat Bergenfelz A, Jansson S, Kristoffersson A, Martensson H, Reihner E, Wallin G, Lausen I (2008) Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg 393(5):667–673PubMedCrossRef Bergenfelz A, Jansson S, Kristoffersson A, Martensson H, Reihner E, Wallin G, Lausen I (2008) Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg 393(5):667–673PubMedCrossRef
4.
Zurück zum Zitat Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I, Dralle H (2000) Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 24(11):1335–1341PubMedCrossRef Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I, Dralle H (2000) Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 24(11):1335–1341PubMedCrossRef
5.
Zurück zum Zitat Godballe C, Madsen AR, Pedersen HB, Sorensen CH, Pedersen U, Frisch T, Helweg-Larsen J, Barfoed L, Illum P, Monsted JE, Becker B, Nielsen T (2009) Post-thyroidectomy hemorrhage: a national study of patients treated at the Danish departments of ENT Head and Neck Surgery. Eur Arch Otorhinolaryngol: Off J Eur Fed Otorhinolaryngol Soc 266(12):1945–1952. doi:10.1007/s00405-009-0949-0 CrossRef Godballe C, Madsen AR, Pedersen HB, Sorensen CH, Pedersen U, Frisch T, Helweg-Larsen J, Barfoed L, Illum P, Monsted JE, Becker B, Nielsen T (2009) Post-thyroidectomy hemorrhage: a national study of patients treated at the Danish departments of ENT Head and Neck Surgery. Eur Arch Otorhinolaryngol: Off J Eur Fed Otorhinolaryngol Soc 266(12):1945–1952. doi:10.​1007/​s00405-009-0949-0 CrossRef
6.
Zurück zum Zitat Rosato L, Avenia N, Bernante P, De PM, Gulino G, Nasi PG, Pelizzo MR, Pezzullo L (2004) Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 28(3):271–276PubMedCrossRef Rosato L, Avenia N, Bernante P, De PM, Gulino G, Nasi PG, Pelizzo MR, Pezzullo L (2004) Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 28(3):271–276PubMedCrossRef
7.
Zurück zum Zitat Aluffi P, Policarpo M, Cherovac C, Olina M, Dosdegani R, Pia F (2001) Post-thyroidectomy superior laryngeal nerve injury. Eur Arch Otorhinolaryngol: Off J Eur Fed Otorhinolaryngol Soc 258(9):451–454CrossRef Aluffi P, Policarpo M, Cherovac C, Olina M, Dosdegani R, Pia F (2001) Post-thyroidectomy superior laryngeal nerve injury. Eur Arch Otorhinolaryngol: Off J Eur Fed Otorhinolaryngol Soc 258(9):451–454CrossRef
8.
Zurück zum Zitat Bellantone R, Boscherini M, Lombardi CP, Bossola M, Rubino F, De Crea C, Alesina P, Traini E, Cozza T, D’Alatri L (2001) Is the identification of the external branch of the superior laryngeal nerve mandatory in thyroid operation? Results of a prospective randomized study. Surgery 130(6):1055–1059. doi:10.1067/msy.2001.118375 PubMedCrossRef Bellantone R, Boscherini M, Lombardi CP, Bossola M, Rubino F, De Crea C, Alesina P, Traini E, Cozza T, D’Alatri L (2001) Is the identification of the external branch of the superior laryngeal nerve mandatory in thyroid operation? Results of a prospective randomized study. Surgery 130(6):1055–1059. doi:10.​1067/​msy.​2001.​118375 PubMedCrossRef
10.
Zurück zum Zitat Reeve TS, Curtin A, Fingleton L, Kennedy P, Mackie W, Porter T, Simons D, Townend D, Delbridge L (1994) Can total thyroidectomy be performed as safely by general surgeons in provincial centers as by surgeons in specialized endocrine surgical units? Making the case for surgical training. Arch Surg 129(8):834–836PubMedCrossRef Reeve TS, Curtin A, Fingleton L, Kennedy P, Mackie W, Porter T, Simons D, Townend D, Delbridge L (1994) Can total thyroidectomy be performed as safely by general surgeons in provincial centers as by surgeons in specialized endocrine surgical units? Making the case for surgical training. Arch Surg 129(8):834–836PubMedCrossRef
12.
Zurück zum Zitat Cerqueira C, Knudsen N, Ovesen L, Laurberg P, Perrild H, Rasmussen LB, Jorgensen T (2010) Nationwide trends in surgery and radioiodine treatment for benign thyroid disease during iodization of salt. Eur J Endocrinol/Eur Fed Endocr Soc 162(4):755–762. doi:10.1530/EJE-09-0965 CrossRef Cerqueira C, Knudsen N, Ovesen L, Laurberg P, Perrild H, Rasmussen LB, Jorgensen T (2010) Nationwide trends in surgery and radioiodine treatment for benign thyroid disease during iodization of salt. Eur J Endocrinol/Eur Fed Endocr Soc 162(4):755–762. doi:10.​1530/​EJE-09-0965 CrossRef
14.
Zurück zum Zitat Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A (2008) Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg 32(7):1358–1366PubMedCrossRef Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A (2008) Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg 32(7):1358–1366PubMedCrossRef
15.
Zurück zum Zitat Sanabria A, Silver CE, Suarez C, Shaha A, Khafif A, Owen RP, Rinaldo A, Ferlito A (2013) Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature. Eur Arch Otorhinolaryngol: Off J Eur Fed Otorhinolaryngol Soc 270(9):2383–2395. doi:10.1007/s00405-013-2558-1 CrossRef Sanabria A, Silver CE, Suarez C, Shaha A, Khafif A, Owen RP, Rinaldo A, Ferlito A (2013) Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature. Eur Arch Otorhinolaryngol: Off J Eur Fed Otorhinolaryngol Soc 270(9):2383–2395. doi:10.​1007/​s00405-013-2558-1 CrossRef
16.
Zurück zum Zitat Randolph GW, Dralle H, Abdullah H, Barczynski M, Bellantone R, Brauckhoff M, Carnaille B, Cherenko S, Chiang FY, Dionigi G, Finck C, Hartl D, Kamani D, Lorenz K, Miccolli P, Mihai R, Miyauchi A, Orloff L, Perrier N, Poveda MD, Romanchishen A, Serpell J, Sitges-Serra A, Sloan T, Van Slycke S, Snyder S, Takami H, Volpi E, Woodson G, International Intraoperative Monitoring Study G (2011) Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope 121(Suppl 1):S1–S16. doi:10.1002/lary.21119 PubMedCrossRef Randolph GW, Dralle H, Abdullah H, Barczynski M, Bellantone R, Brauckhoff M, Carnaille B, Cherenko S, Chiang FY, Dionigi G, Finck C, Hartl D, Kamani D, Lorenz K, Miccolli P, Mihai R, Miyauchi A, Orloff L, Perrier N, Poveda MD, Romanchishen A, Serpell J, Sitges-Serra A, Sloan T, Van Slycke S, Snyder S, Takami H, Volpi E, Woodson G, International Intraoperative Monitoring Study G (2011) Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope 121(Suppl 1):S1–S16. doi:10.​1002/​lary.​21119 PubMedCrossRef
17.
Zurück zum Zitat Sadowski SM, Soardo P, Leuchter I, Robert JH, Triponez F (2013) Systematic use of recurrent laryngeal nerve neuromonitoring changes the operative strategy in planned bilateral thyroidectomy. Thyroid 23(3):329–333. doi:10.1089/thy.2012.0368 PubMedCrossRef Sadowski SM, Soardo P, Leuchter I, Robert JH, Triponez F (2013) Systematic use of recurrent laryngeal nerve neuromonitoring changes the operative strategy in planned bilateral thyroidectomy. Thyroid 23(3):329–333. doi:10.​1089/​thy.​2012.​0368 PubMedCrossRef
18.
Zurück zum Zitat Barczynski M, Randolph GW, Cernea CR, Dralle H, Dionigi G, Alesina PF, Mihai R, Finck C, Lombardi D, Hartl DM, Miyauchi A, Serpell J, Snyder S, Volpi E, Woodson G, Kraimps JL, Hisham AN, International Neural Monitoring Study G (2013) External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: international neural monitoring study group standards guideline statement. Laryngoscope 123 Suppl 4:S1–S14. doi:10.1002/lary.24301 PubMedCrossRef Barczynski M, Randolph GW, Cernea CR, Dralle H, Dionigi G, Alesina PF, Mihai R, Finck C, Lombardi D, Hartl DM, Miyauchi A, Serpell J, Snyder S, Volpi E, Woodson G, Kraimps JL, Hisham AN, International Neural Monitoring Study G (2013) External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: international neural monitoring study group standards guideline statement. Laryngoscope 123 Suppl 4:S1–S14. doi:10.​1002/​lary.​24301 PubMedCrossRef
Metadaten
Titel
Risk factors for recurrent nerve palsy after thyroid surgery: a national study of patients treated at Danish departments of ENT Head and Neck Surgery
verfasst von
Christian Godballe
Anders Rørbæk Madsen
Christian Hjort Sørensen
Sten Schytte
Waldemar Trolle
Jens Helweg-Larsen
Lisa Barfoed
Larry Kristiansen
Vibeke Zederkof Sørensen
Grethe Samuelsen
Henrik Baymler Pedersen
Publikationsdatum
01.08.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
European Archives of Oto-Rhino-Laryngology / Ausgabe 8/2014
Print ISSN: 0937-4477
Elektronische ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-013-2767-7

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