Analysis of Risk Factors for Phonation Disorders after Thyroid Surgery
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Data Collection
2.3. Statistical Analysis
3. Results
3.1. Paralysis of the Vocal Cords Immediately after Thyroid Surgery
- The presence of a retrosternal goiter (chi2 = 15.1; p = 0.0001, OR 2.8, 95%CI 1.63–4.82). In the group of patients with early vocal cord paralysis, the percentage of patients with a retrosternal goiter was 42.1%; in the group of patients without complications, this percentage constituted only 20.6%. An odds ratio (OR) value of 2.8 indicates that the presence of a retrosternal goiter increases the probability of early vocal cord paralysis almost three-fold.
- Whether the operation was primary or secondary (chi2 = 4.9; p = 0.027, OR 2.25, 95%Cl: 1.34–3.77). In the group of patients with early vocal cord paralysis, the percentage of patients for whom it was secondary surgery was 15.8%, and in the group of patients without paralysis it was only 7.7%. In the group of patients for whom it was secondary surgery, the probability of complications was about 2.3 times higher than in the group of patients for whom it was primary surgery (OR = 2.25).
- The indication for surgery (chi2 = 14.5; p = 0.0023). In the group of patients with early vocal cord paralysis, the percentage of patients for whom the indication for surgery was thyroid cancer was 23.0%. The probability of vocal cord paralysis in the group of people with this indication was about 3.4 times higher than in the group of patients with other indications (OR = 3.38, 95% Cl: 1.721–6.651) according to the logistic regression model.
3.2. Transient Paralysis of the Vocal Cords
- The presence of a retrosternal goiter (chi2 = 8.3; p = 0.0041, OR 2.57, Cl: 1.32–5.03). In the group of patients with transient paralysis of the vocal cords, the percentage of patients with retrosternal goiters was 40.5%; in the group of patients without paralysis, this percentage was only 20%. The OR value of 2.57 indicates that the presence of retrosternal goiter increases the probability of transient paralysis of the vocal cords 2.5-fold.
- The age of the patient (age ≤65 years/age >65; chi2 = 5.2; p = 0.02, OR 2.2, 95%Cl: 1.1–4.34). In the group of patients with transient vocal cord paralysis, the percentage of patients over 65 years in age was 35%, and in the group of patients without complications, this percentage was only 20%. The OR value of 2.2 indicates that age above 65 years more than doubles the probability of transient paralysis of the vocal cords.
3.3. Permanent Paralysis of the Vocal Cords
- The presence of a retrosternal goiter (chi2 = 6.77; p = 0.009, OR 3.06, 95%Cl: 1.26–7.46). In the group of patients with permanent paralysis of the vocal cords, the percentage of patients with retrosternal goiter was 45%, and in the group of patients without paralysis, this percentage amounted to only 21%. The OR value of 3.06 indicates that the presence of a retrosternal goiter increases the probability of permanent vocal cord paralysis almost three-fold.
- Whether the operation under consideration was primary or secondary (chi2 = 3.97; p = 0.046, OR 2.94, 95%Cl: 0.97–8.94). In the group of patients with permanent vocal cord paralysis, the percentage of patients for whom it was secondary surgery was 20%; in the group of patients without complications, it was only 7.8%. In the group of patients for whom the surgery was secondary, the probability of permanent paralysis was approximately three times higher than in the group of patients for whom it was primary surgery (OR = 2.94).
- The indication for surgery (chi2 = 31.5; p = 0.00000). In the group of patients with permanent vocal cord paralysis, the percentage of patients for whom the indication for surgery was thyroid cancer was 35.0%. The probability of paralysis in the group of people with this indication was about 10 times higher than in the group of patients with other indications (OR = 10.71, 95%Cl: 3.351–34.202) according to the logistic regression model).
- The presence of a single or multiple focal lesions in the thyroid vs. parenchymal goiter (chi2 = 28.25; p < 0.00001). In the group of patients with permanent vocal cord paralysis, the percentage of patients with a parenchymal goiter was 20.0%. The probability of complications in the group of patients with this type of lesion was about four times higher than in the group of patients with single or multiple tumors (OR = 3.77, 95%Cl: 1.055–13.507) according to the logistic regression model.
- Goiter volume (chi2 = 8.82; p = 0.012). In the group of patients with permanent cord paralysis, the percentage of patients with large goiters (>100 mL) was 20.0%. The probability of complications in the group of people with this size goiter was about five times higher than in the group of patients with goiters up to 100 mL (OR = 5.02, 95%Cl: 1.538–16.387) according to the logistic regression model.
3.4. Meta-Analysis
- Secondary surgery (secondary surgery = 1/primary surgery = 0; (OR = 2.94; 95%Cl: 0.97–8.94, p = 0.05): the result is on the verge of statistical significance);
- Total volume (mL) (V > 100 = 1/V ≤ 100 = 0; (OR = 4.62; 95%Cl: 1.51–14.15, p = 0.0074))
- Retrosternal goiter (present = 1; (OR = 3.06; 95%Cl: 1.26–7.46, p = 0.0132));
- Duration of operation (t > median (55 min) = 1/t ≤ median = 0; (OR = 1.79; 95%Cl: 1.03–7.03, p = 0.009));
- Diagnosis of carcinoma (yes = 1; OR = 5.32, 95%CL: 2.09–13.56, p = 0.0005)).
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
RLN | recurrent laryngeal nerve |
EBSLN | external branch of the superior laryngeal nerve |
RLN at risk | recurrent laryngeal nerve at risk of damage |
BMI | body mass index |
GD | Graves’ disease |
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Number of Patients, n (%) | 830 (100%) |
---|---|
Number of RLN at risk of injury (RLN/at risk) | 1500 |
Age, mean ± standard deviation Minimum/maximum age (years) | 54.1 ± 14.2 17/86 |
Gender (F: M) | 691:139 |
BMI, mean ± standard deviation (kg/m2) BMI minimum/maximum | 26.2 ± 3.6 13/46 |
Tracheal displacement/constriction, n (%) | 349 (42%) |
Retrosternal goiter, n (%) | 171 (21%) |
Thyroid volume (V), mean ± standard deviation V minimum/maximum (ml) | 42.2 ± 31.3 1/210 |
Primary surgery, n (%) | 761 (92%) |
Secondary surgery, n (%) | 69 (8%) |
Diagnosis, n (%) | |
• Nodular goiter | 591 (71.2%) |
• Toxic nodular goiter | 131 (15.8%) |
Graves’ disease | 32 (3.8%) |
• Carcinoma | 76 (9.2%) |
− Papillary thyroid cancer − Follicular thyroid cancer − Medullary thyroid cancer − Anaplastic thyroid cancer | 65 (7.8%) 8 (1.1%) 2 (0.2%) 1 (0.1%) |
Thyroid surgery n (%) | |
• Total thyroidectomy | 495 (59.6%) |
• Excision of a thyroid lobe with the isthmus | 160 (19.3%) |
• Almost total thyroidectomy | 86 (10.4%) |
• Dunhill procedure | 45 (5.4%) |
• Subtotal bilateral thyroidectomy | 44 (5.3%) |
Complication Risk Factor Symbol | Risk Factor for Complications of Vocal Cord Paralysis | Number of RLNs at Risk of Injury n = 1500 (100%) | |
---|---|---|---|
Vnz1 | RLN identification | Visual | 1031 (69%) |
Neuromonitoring | 469 (31%) | ||
Vnz2 | Age | ≤65 y | 1196 (80%) |
>65 y | 304 (20%) | ||
Vnz3 | Gender | Female | 1245 (83%) |
Male | 255 (17%) | ||
Vnz4 | Thyroid surgery | Primary | 1380 (92%) |
Secondary | 120 (8%) | ||
Vnz5 | Trachea | Normal | 863 (57%) |
Displaced/Constricted | 638 (43%) | ||
Vnz6 | Retrosternal goiter | Absent | 1179 (80%) |
Present | 321 (20%) | ||
Vnz7 | Scope of thyroid surgery | Total thyroid lobectomy | 1367 (91%) |
Partial thyroid lobectomy | 133 (9%) | ||
Vzn8 | Surgeon/Experience | ≤100 surgeries/year | 304 (20%) |
>100 surgeries/year | 80 (80%) | ||
Vnz9 | Clinical diagnosis | Nodular goiter | 1045 (70%) |
Toxic nodular goiter | 248 (16%) | ||
Graves’ disease | 64 (4%) | ||
Carcinoma | 143 (10%) | ||
Vzn10 | Focal lesion | Single | 258 (17%) |
Multiple | 1200 (80%) | ||
Parenchymal goiter | 42 (3%) | ||
Vzn11 | Type of procedure | Total thyroidectomy | 1195 (79.7%) |
Partial thyroid lobectomy | 133 (8.8%) | ||
Almost total thyroidectomy | 173 (11.5%) | ||
Vzn12 | BMI | Underweight | 25 (2%) |
Normal | 520 (35%) | ||
Overweight | 799 (53%) | ||
Obesity | 156 (10%) | ||
Vnz13 | Total volume | ≤40 mL | 964 (64%) |
>40 mL ≤100 mL | 456 (31%) | ||
>100 mL | 80 (5%) | ||
Vnz14 | Age–raw score | Age, mean ± standard deviation 54.1 ± 14.2 Minimum age–maximum 17–86 | 1500 (100%) |
Vnz15 | BMI—raw score | BMI, mean ± standard deviation (kg/m2) 26.2 ± 3.6, min-max 13/46 | 1500 (100%) |
Vnz16 | Volume—raw result | Thyroid volume * (V), mean ± standard deviation 42.2 ± 31.3 V minimum–maximum [mL] 1–210 | 1500 (100%) |
Vnz17 | Duration of operation—raw result | Time, mean ± standard deviation 58.3 ± 18.2 (min) Median 55 min | 1500 (100%) |
Complications Risk Factors | End Points | OR | Standard Error | “−95% CI” | “+95% CI” | p | Meta-Analysis in Subgroups, % Share | OR | Standard Error | “–95% CI” | “+95% CI” | p | Share % |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Visualization_ (YES = 1) Age_ (>65 years = 1) Gender_ (M = 1) Secondary surgery_ (YES = 1) BMI_ (obesity = 1) Total volume_ (V > 100 = 1) Narrow trachea_ (YES = 1) Retrosternal goiter_ (YES = 1) Surgeon’s experience_ (YES = 1) Duration of operation_ (t> median = 1) Indication: Carcinoma_ (YES = 1) | Vz1_ (n = 57) | 1.74 1.71 1.79 2.25 1.65 3.11 1.06 2.81 0.85 2.00 2.98 | 0.57 0.51 0.55 0.85 0.62 1.24 0.29 0.77 0.28 0.56 0.98 | 0.91 0.96 0.98 1.08 0.79 1.42 0.62 1.63 0.45 1.16 1.57 | 3.32 3.06 3.28 4.71 3.44 6.81 1.80 4.82 1.61 3.46 5.68 | 0.0937 0.0702 0.0595 0.0312 0.1784 0.0046 0.8364 0.0002 0.6270 0.0132 0.0009 | 49.99% 50.10% 49.40% 49.28% 49.81% 49.16% 48.20% 49.37% 49.54% 49.87% 33.36% | 1.83 | 0.23 | 1.44 | 2.33 | 0.0000 | 8.77% 9.94% 9.49% 7.38% 7.46% 6.78% 10.94% 10.78% 9.02% 10.63% 8.80% |
Visualization_ (YES = 1) Age_ (> 65 years = 1) Gender_ (M = 1) Secondary surgery_ (YES = 1) BMI_ (obesity = 1) Total volume_ (V > 100 = 1) Narrow trachea_ (YES = 1) Retrosternal goiter_ (YES = 1) Surgeon’s experience_ (YES = 1) Duration of operation_ (t > median = 1) Indication: Carcinoma_ (YES = 1) | Vz2_ (n = 37) | 1.43 2.18 1.84 1.83 2.06 2.21 1.00 2.58 0.92 1.69 1.00 | 0.55 0.76 0.69 0.90 0.88 1.20 0.32 0.88 0.37 0.57 0.13 | 0.67 1.10 0.88 0.70 0.89 0.76 0.53 1.32 0.42 0.87 0.78 | 3.05 4.34 3.85 4.79 4.77 6.40 1.87 5.03 2.03 3.28 1.28 | 0.3587 0.0261 0.1052 0.2174 0.0922 0.1432 1.0000 0.0055 0.8356 0.1221 1.0000 | 36.25% 35.95% 33.23% 29.02% 37.84% 26.74% 34.88% 32.37% 31.45% 33.94% 37.42% | 1.49 | 0.19 | 1.16 | 1.92 | 0.0019 | 7.89% 9.05% 8.20% 5.53% 6.81% 4.70% 10.17% 9.38% 7.41% 9.46% 21.41% |
Visualization_ (YES = 1) Age_ (>65 years = 1) Gender_ (M = 1) Secondary surgery_ (YES = 1) BMI_ (obesity = 1) Total volume_ (V > 100 = 1) Narrow trachea_ (YES = 1) Retrosternal goiter_ (YES = 1) Surgeon’s experience_ (YES = 1) Duration of operation_ (t> median = 1) Indication: Carcinoma_ (YES = 1) | Vz3_ (n = 20) | 2.60 0.98 1.64 2.94 0.96 4.62 0.90 3.06 0.76 2.69 5.32 | 1.64 0.55 0.85 1.67 0.72 2.64 0.41 1.39 0.40 1.32 2.54 | 0.76 0.33 0.59 0.97 0.22 1.51 0.37 1.26 0.27 1.03 2.09 | 8.93 2.96 4.55 8.94 4.16 14.15 2.21 7.46 2.11 7.03 13.56 | 0.1279 0.9762 0.3424 0.0573 0.9530 0.0074 0.8176 0.0137 0.5971 0.0441 0.0005 | 13.76% 13.95% 17.37% 21.70% 12.35% 24.10% 16.92% 18.26% 19.01% 16.19% 29.22% | 2.0 | 0.43 | 1.32 | 3.04 | 0.0011 | 7.50% 8.62% 9.43% 8.54% 5.87% 8.46% 10.78% 10.91% 9.44% 10.07% 10.37% |
Summary—Effect of Interaction in Subgroups. Meta-Analysis in Subgroups | |||||||||||||
Visualization_ (YES = 1) Age_ (>65 years = 1) Gender_ (M = 1) Secondary surgery_ (YES = 1) BMI_ (obesity = 1) Total volume_ (V > 100 = 1) Narrow trachea_ (YES = 1) Retrosternal goiter_ (YES = 1) Surgeon’s experience_ (YES = 1) Duration of operation_ (t > median = 1) Indication: Carcinoma_ (YES = 1) | Vz1 + Vz2 + Vz3 n = 57 + 37 + 20 | 1.71 1.73 1.78 2.25 1.68 3.12 1.01 2.77 0.86 1.98 2.35 | 0.40 0.36 0.39 0.59 0.44 0.88 0.19 0.54 0.19 0.39 1.25 | 1.08 1.15 1,16 1.34 1.00 1.80 0.70 1.90 0.55 1.35 0.83 | 2.70 2.61 2.72 3.77 2.81 5.41 1.46 4.06 1.33 2.92 6.65 | 0.0213 0.0092 0.0079 0.0022 0.0494 0.0000 0.9613 0.0000 0.4909 0.0005 0.1083 | 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% | ||||||
Summary | 1.73 | 0.12 | 1.51 | 1.98 | 0.0000 | - |
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Głód, M.; Marciniak, D.; Kaliszewski, K.; Sutkowski, K.; Rudnicki, J.; Bolanowski, M.; Wojtczak, B. Analysis of Risk Factors for Phonation Disorders after Thyroid Surgery. Biomedicines 2022, 10, 2280. https://doi.org/10.3390/biomedicines10092280
Głód M, Marciniak D, Kaliszewski K, Sutkowski K, Rudnicki J, Bolanowski M, Wojtczak B. Analysis of Risk Factors for Phonation Disorders after Thyroid Surgery. Biomedicines. 2022; 10(9):2280. https://doi.org/10.3390/biomedicines10092280
Chicago/Turabian StyleGłód, Mateusz, Dominik Marciniak, Krzysztof Kaliszewski, Krzysztof Sutkowski, Jerzy Rudnicki, Marek Bolanowski, and Beata Wojtczak. 2022. "Analysis of Risk Factors for Phonation Disorders after Thyroid Surgery" Biomedicines 10, no. 9: 2280. https://doi.org/10.3390/biomedicines10092280
APA StyleGłód, M., Marciniak, D., Kaliszewski, K., Sutkowski, K., Rudnicki, J., Bolanowski, M., & Wojtczak, B. (2022). Analysis of Risk Factors for Phonation Disorders after Thyroid Surgery. Biomedicines, 10(9), 2280. https://doi.org/10.3390/biomedicines10092280