Short-Term Outcomes of Surgery for Graves’ Disease in Germany
Abstract
:1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgements
Conflicts of Interest
References
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No. of Operations for GD/Evaluation Period | No. of Institutions n = 78 | No. of Patients with GD n = 1808 | Postoperative Hypoparathyroidism n = 525 | Postoperative RLNP (per NAR) | Re-Operations Due to Bleeding |
---|---|---|---|---|---|
<10 | 38 (49%) | 155 (8.6%) | 72 (46.5%) | 15/279 (5.4%) | 1 (0.6%) |
11–30 | 22 (28%) | 411 (22.7%) | 143 (34.8%) | 42/772 (5.4%) | 5 (1.2%) |
31–50 | 7 (9%) | 280 (15.5%) | 62 (22.1%) | 26/533 (4.9%) | 3 (1.1%) |
>51 | 11 (14%) | 962 (53.2%) | 248 (25.8%) | 55/1845 (3.0%) | 14 (1.5%) |
Parameter | % (n) |
---|---|
female | 81.7% (1478) |
age < 18 years | 2.4% (43) |
age > 70 years | 3.5% (64) |
BMI > 35 | 7.2% (131) |
ASA 1/2 | 89.3% (1615) |
Endocrine orbitopathy | 35.7% (645) |
Biochemical hyperthyroidism at operation | 55.3% (999) |
Thyrotoxic crisis at operation | 0.3% (6) |
Preoperative vocal cord assessment | 98.5% (1780) |
Preoperative VCP | 0.3% (6) |
Previous neck surgery | 3.8% (68) |
Type of Surgery | Number (%) |
---|---|
Total thyroidectomy | 1668 (92.3%) |
Hemithyroidectomy | 98 (5.4%) |
Hemithyroidectomy, contralateral node excision | 4 (0.2%) |
Hemithyroidectomy, contralateral subtotal resection | 14 (0.8%) |
Unilateral subtotal resection | 3 (0.2%) |
Bilateral subtotal resection | 10 (0.6%) |
Other resections (e.g., isthmus resection, node excision) | 11 (0.6%) |
All procedures | 1808 (100%) |
Parameter | Number of NAR (%) | Unilateral RLNP * per NAR | Bilateral RLNP * per NAR | Postoperative not Examined |
---|---|---|---|---|
NAR | 3429 * (100%) | 134 (3.9%) | 4 (0.1%) | 97 (2.8%) |
only visualization RLN | 16 (0.5%) | 0 (0%) | 0 (0%) | 0 (0%) |
IONM | 3409 (99.4%) | 134 (3.9%) | 4 (0.1%) | 95 (2.8%) |
intermittent IONM | 2656 (77.4%) | 108 (4.1%) | 4 (0.1%) | 72 (2.7%) |
continuous IONM | 753 (22.0%) | 26 (3.4%) | 0 (0%) | 23 (3.1%) |
no visualization, no IONM | 4 (0.1%) | 0 (0%) | 0 (0%) | 2 (50%) |
Parameter | Number of Patients | Number of Patients with Transient Postoperative Hypoparathyroidism * | p-Value |
---|---|---|---|
All patients | 1808 (100%) | 525 (29.0%) | |
no PG identified | 31 (1.7%) | 8 (25.8%) | |
any PG identified | 1777 (98.3%) | 517 (29.1%) | 0.69 |
1 PG identified | 30 (1.6%) | 5 (16.6%) | |
2 or more PGs identified | 1747 (96.6%) | 512 (29.3%) | |
no PG autotransplanted | 1433 (79.3%) | 362 (25.2%) | <0.0001 |
any PG autotransplanted | 375 (20.7%) | 163 (43.5%) | |
1 PG autotransplanted | 3 (0.1%) | 3 (100%) | |
2 PG autotransplanted | 327 (18.1%) | 131 (40.1%) | |
1 or 2 PG autotransplanted | 330 (18.3%) | 134 (40.6%) | |
>2 PG autotransplanted | 45 (2.5%) | 29 (64.4%) |
Parameter | Univariate Analysis | Multivariate Analysis | ||
---|---|---|---|---|
OR (95% CI) | p-Value | OR (95% CI) | p-Value | |
Case load GD/study period > 30 | 0.543 (0.439–0.672) | <0.0005 | 0.490 (0.393–0.611) | <0.0005 |
Case load thyroid resection/year > 301 | 1.759 (1.351–2.290) | <0.0005 | 0.501 (0.392–0.640) | <0.0005 |
Age > 50 years | 0.660 (0.531–0.819) | <0.0005 | 0.690 (0.552–0.864) | 0.001 |
BMI > 30 | 0.701 (0.520–0.944) | 0.019 | 1.349 (1.064–1.711) | 0.014 |
Male gender | 0.580 (0.434–0.774) | <0.0005 | 0.666 (0.494–0.897) | 0.007 |
Previous bilateral thyroid/parathyroid surgery | 0.310 (0.109–0.883) | 0.028 | 0.330 (0.114–0.959) | 0.042 |
Autotransplantation PG | 2.275 (1.796–2.881) | <0.0005 | 2.276 (1.786–2.902) | <0.0005 |
Surgical method minimally invasive | 1.370 (0.547–3.430) | 0.502 | ||
Previous neck surgery overall | 0.683 (0.381–1.222) | 0.199 | ||
Lymphadenectomy | 0.620 (0.375–1.02) | 0.063 | ||
Thyroid volume > 100 g | 1.170 (0.689–1.985) | 0.080 | ||
Preoperative TSH level | 0.913 (0.737–1.131) | 0.405 | ||
Preoperative PTH level | 0.848 (0.496–1.451) | 0.548 |
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Maurer, E.; Vorländer, C.; Zielke, A.; Dotzenrath, C.; von Frankenberg, M.; Köhler, H.; Lorenz, K.; Weber, T.; Jähne, J.; Hammer, A.; et al. Short-Term Outcomes of Surgery for Graves’ Disease in Germany. J. Clin. Med. 2020, 9, 4014. https://doi.org/10.3390/jcm9124014
Maurer E, Vorländer C, Zielke A, Dotzenrath C, von Frankenberg M, Köhler H, Lorenz K, Weber T, Jähne J, Hammer A, et al. Short-Term Outcomes of Surgery for Graves’ Disease in Germany. Journal of Clinical Medicine. 2020; 9(12):4014. https://doi.org/10.3390/jcm9124014
Chicago/Turabian StyleMaurer, Elisabeth, Christian Vorländer, Andreas Zielke, Cornelia Dotzenrath, Moritz von Frankenberg, Hinrich Köhler, Kerstin Lorenz, Theresia Weber, Joachim Jähne, Antonia Hammer, and et al. 2020. "Short-Term Outcomes of Surgery for Graves’ Disease in Germany" Journal of Clinical Medicine 9, no. 12: 4014. https://doi.org/10.3390/jcm9124014