Does Completion Thyroid Surgery Pose a Higher Risk of Complications?

Abstract

Introduction: The outcomes of completion thyroidectomy are not well-documented. The study aim is to compare the risks of total thyroidectomy (TT), thyroid lobectomy (TL), and completion thyroidectomy (CT) using a large multi-institutional database.

Methods: All cases of thyroidectomy without lymphadenectomy were identified using the CESQIP national database (2013-2023). Completion thyroidectomy was defined as contralateral lobectomy following previous lobectomy. Outcomes were examined including hematoma requiring evacuation, vocal cord dysfunction on post-op laryngoscopy, and clinical concern for hypoparathyroidism.

Results: Among 33,154 cases, TT, TL, and CT were performed in 19,057 (57%), 13,135 (40%) and 962 (3%), respectively. 30-day hematoma rates were overall low: 135 (0.8%) in TT, 57 (0.5%) in TL, and < 10 (0.7%) in CT (p < 0.01). 30-day vocal cord dysfunction was documented in 233 (1.4%), 159 (1.3%), and < 10 (1.0%) for TT, TL, and CT, respectively (p = 0.65). Temporary hypoparathyroidism was more common after TT than CT (989 (6%) versus 20 (2%), p < 0.01). Among 16,311 (49%) patients with reported long-term outcomes, there were no differences in the rates of vocal cord dysfunction by type of operation (p = 0.34). However, long-term hypoparathyroidism was more likely after TT than CT (237 (2.5%) versus < 10 (0.7%), p < 0.01).

Conclusion: In this multi-institutional endocrine surgery database, the reported long-term complication rates after completion thyroidectomy were the same as for first-time thyroid lobectomy. However, clinical hypoparathyroidism was 2.5-fold more likely for total thyroidectomy than for completion thyroidectomy at 30-days and remained 3.7-fold higher in the long term suggesting that completion thyroidectomy does not pose a higher risk of complications.