TY - JOUR
T1 - Identifying predictors of a difficult thyroidectomy
AU - Mok, Valerie M.
AU - Oltmann, Sarah C.
AU - Chen, Herbert
AU - Sippel, Rebecca S.
AU - Schneider, David F.
N1 - Funding Information:
Author contributions: V.M.M. and D.F.S contributed to the drafting of the article and the acquisition of data. D.F.S., S.C.O., H.C., and R.S.S. did the critical revision. The authors thank the University of Wisconsin Shapiro Summer Research Program for funding this research project.
PY - 2014/7
Y1 - 2014/7
N2 - Background A Thyroidectomy Difficulty Scale (TDS) was previously developed that identified more difficult operations, which correlated with longer operative times and higher complication rates. The purpose of this study was to identify preoperative variables predictive of a more difficult thyroidectomy using the TDS. Methods A four item, 20-point TDS, was used to score the difficulty of thyroid operations. Patient and disease factors were recorded for each patient. Difficult thyroidectomy and non-difficult thyroidectomy (NDT) patients were compared. A final multivariate logistic regression model was constructed with significant (P < 0.05) variables from a univariate analysis. Results A total of 189 patients were scored using TDS. Of them, 69 (36.5%) suffered from hyperthyroidism, 42 (22.2%) from Hashimotos, 34 (18.0%) from thyroid cancer, and 36 (19.0%) from multinodular goiter. Among hyperthyroid patients, the DT group had a greater number preoperatively treated with Lugols potassium iodide (81.6% DT versus 58.1% NDT, P = 0.032), presence of ophthalmopathy (31.6% DT versus 9.7% NDT, P = 0.028), and presence of (>4 IU/mL) antithyroglobulin antibodies (34.2% DT versus 12.9% NDT, P = 0.05). Using multivariate analysis, hyperthyroidism (odds ratio [OR], 4.35, 95% confidence interval [CI], 1.23-15.36, P = 0.02), presence of antithyroglobulin antibody (OR, 3.51, 95% CI, 1.28-9.66, P = 0.015), and high (>150 ng/mL) thyroglobulin (OR, 2.61, 95% CI, 1.06-6.42, P = 0.037) were independently associated with DT. Conclusions Using TDS, we demonstrated that a diagnosis of hyperthyroidism, preoperative elevation of serum thyroglobulin, and antithyroglobulin antibodies are associated with DT. This tool can assist surgeons in counseling patients regarding personalized operative risk and improve OR scheduling.
AB - Background A Thyroidectomy Difficulty Scale (TDS) was previously developed that identified more difficult operations, which correlated with longer operative times and higher complication rates. The purpose of this study was to identify preoperative variables predictive of a more difficult thyroidectomy using the TDS. Methods A four item, 20-point TDS, was used to score the difficulty of thyroid operations. Patient and disease factors were recorded for each patient. Difficult thyroidectomy and non-difficult thyroidectomy (NDT) patients were compared. A final multivariate logistic regression model was constructed with significant (P < 0.05) variables from a univariate analysis. Results A total of 189 patients were scored using TDS. Of them, 69 (36.5%) suffered from hyperthyroidism, 42 (22.2%) from Hashimotos, 34 (18.0%) from thyroid cancer, and 36 (19.0%) from multinodular goiter. Among hyperthyroid patients, the DT group had a greater number preoperatively treated with Lugols potassium iodide (81.6% DT versus 58.1% NDT, P = 0.032), presence of ophthalmopathy (31.6% DT versus 9.7% NDT, P = 0.028), and presence of (>4 IU/mL) antithyroglobulin antibodies (34.2% DT versus 12.9% NDT, P = 0.05). Using multivariate analysis, hyperthyroidism (odds ratio [OR], 4.35, 95% confidence interval [CI], 1.23-15.36, P = 0.02), presence of antithyroglobulin antibody (OR, 3.51, 95% CI, 1.28-9.66, P = 0.015), and high (>150 ng/mL) thyroglobulin (OR, 2.61, 95% CI, 1.06-6.42, P = 0.037) were independently associated with DT. Conclusions Using TDS, we demonstrated that a diagnosis of hyperthyroidism, preoperative elevation of serum thyroglobulin, and antithyroglobulin antibodies are associated with DT. This tool can assist surgeons in counseling patients regarding personalized operative risk and improve OR scheduling.
KW - Difficult thyroidectomy
KW - Difficulty scale
KW - Graves disease
KW - Hashimotos thyroiditis
KW - Risk adjustment
KW - Thyroid
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U2 - 10.1016/j.jss.2014.03.034
DO - 10.1016/j.jss.2014.03.034
M3 - Article
C2 - 24750986
AN - SCOPUS:84902288370
SN - 0022-4804
VL - 190
SP - 157
EP - 163
JO - Journal of Surgical Research
JF - Journal of Surgical Research
IS - 1
ER -