Experience of thyroid surgery at tertiary referral centers in Jazan Hospitals, Saudi Arabia

Post-thyroidectomy hypoparathyroidism: A clinical surgical dilemma

Thyroid dysfunction directly affects human health and overall well-being; various approaches are available for the treatment of thyroid diseases, including conservative measures and surgical interventions. Despite advancements in conservative treatment, surgery remains the preferred option. Hypoparathyroidism is the primary cause of hospitalization after thyroidectomy, leading to cost-related concerns and a detrimental impact on patients' overall quality of life. Postoperative hypoparathyroidism can result in hypocalcemia, and these are challenging conditions that must be identified promptly to prevent immediate and long-term complications. This article focused on the presentation, risk factors, and management of hypoparathyroidism to increase awareness of the risks associated with certain variables, thereby enhancing our ability to predict the risk of this condition. Furthermore, this review highlighted the surgical techniques that may be utilized to prevent hypoparathyroidism. These considerations can help guide preoperative discussions regarding the benefits and potential risks of thyroidectomy.

Safety of thyroidectomy as day care surgery at a rural setting in Eastern Uganda

BACKGROUND

The practice of day care surgery is less embraced in many low-middle-income countries (LMIC), and even less for some procedures considered major such as thyroidectomy. Here we examine the safety of day care thyroidectomy at Kyabirwa Surgical Center, a stand-alone day care surgery center in rural Eastern Uganda.

METHODS

This was a retrospective cohort study conducted between 2019 and 2023. All patients who had day care thyroidectomy were included. Demographics, diagnosis, investigation findings, pathology reports, and surgery outcomes were collected. Postoperative follow-up data up to 30 days were also collected. Data were analyzed using R version 4.3.2.

RESULTS

A total of 51 patients underwent same-day thyroidectomy, with an average age of 44.9 ± 12.1 years and 98% female. Procedures included total thyroidectomy (5, 9.8%), subtotal thyroidectomy (26, 51.0%), and lobectomy (20, 39.2%). Average size of the glands was 7.9 ± 2.21 cm. The majority 46 (90.2%) were of benign pathology. All patients were discharged by the evening of the same day. Complications encountered included hypocalcemia (1), hypertrophic scar (1), seroma (2), and transient recurrent laryngeal nerve injury (1). Overall complications rate was 9.8%. Gland size was statistically significant between patients with no complications (7.68 ± 2.06 cm) versus complications (9.90 ± 2.82, p < 0.05).

CONCLUSION

With overall low complication rates, these findings suggest that thyroidectomy can safely be performed on a day care basis in a rural LMIC setting with suboptimal health care delivery.

Video Documentation in Thyroidectomy and an Evaluation of Operative Notes

Introduction Accurate and detailed documentation of surgical operation notes is crucial for post-operative care, research and academic purposes, and medico-legal clarity. Several studies have shown their defiency and inaccuracy sometimes, and some methods have been proposed to make them more objective. This study aimed to evaluate the completeness of thyroidectomy operative notes in a tertiary center and to assess the adequacy of video documentation by comparing it to the corresponding operative notes. Methods A retrospective review of thyroidectomy operative notes from 2010 to 2020 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, was performed to ensure completeness. Subsequently, 15 thyroidectomies were video recorded, and their notes were compared to the corresponding written operative notes. The completeness score was calculated based on an item list that included items that had to be included in an operative note. An independent samples t-test was used to compare the completeness score means between the two groups. One-way analysis of variance was used to compare the completeness score means between two or more groups. Result A total of 385 thyroidectomy-operative notes were retrospectively reviewed. The completeness scores ranged between 6% and 89% for the various items that had to be documented, with a mean of 54.47%. The mean score of the video-documented operative record was 83.86%±12.84%, which was significantly higher than the corresponding written operative notes (47.53%±18.06%) (p <0.001). Conclusion Video documentation showed significant improvement compared to the corresponding written and retrospective operative notes. Video recording can also be a valuable tool when teaching anatomy and surgical skills and conducting research.

Recurrent laryngeal nerve injury after thyroidectomy: A national study from Saudi Arabia

OBJECTIVES

To determine the incidence and possible risk factors of recurrent laryngeal nerve injury, to provide a relevant literature review of studies from other centers in Saudi Arabia, and to present basic statistical data for future studies in our local community.

METHODS

A retrospective study enrolled patients who were surgically treated for thyroid disease between January 2015 and December 2021. For concerns during the procedure, direct laryngoscopy was carried out before extubation to assess the vocal cords. Similarly, indirect laryngoscopy was carried out for patients who developed postoperative voice changes. All patients were evaluated clinically 2-3 weeks after surgery. Nerve monitors were not used in either case.

RESULTS

The study examined 437 participants: 361 (82.6%) female and 76 (17.4%) male individuals. The incidence of recurrent laryngeal nerve injury was 1.1%. The demographic characteristics, pathology (benign vs. malignant), and extent of thyroidectomy were not significantly associated with the risk of recurrent laryngeal nerve injury.

CONCLUSION

A recurrent laryngeal nerve injury is a serious complication, and further studies are required to determine the safest techniques for thyroidectomy. However, centralization of thyroid surgery in high-volume centers might reduce this risk.

Post-thyroidectomy complications in southwestern Saudi Arabia: a retrospective study of a 6-year period

BACKGROUND

Thyroidectomy is the surgical removal of all or part of the thyroid gland for non-neoplastic and neoplastic thyroid diseases. Major postoperative complications of thyroidectomy, including recurrent laryngeal nerve injury, hypocalcemia, and hypothyroidism, are not infrequent.

OBJECTIVE

Summarize the frequency of surgical complications of thyroidectomy.

DESIGN

Retrospective.

SETTING

Secondary health facility in southwestern Saudi Arabia.

PATIENTS AND METHODS

We collected data from the records of patients who were managed for thyroid diseases between December 2013 and December 2019.

MAIN OUTCOME MEASURE

Complications following thyroidectomy.

SAMPLE SIZE

339 patients, 280 (82.6%) females and 59 (17.4%) males.

RESULTS

We found 311 (91.7%) benign and 28 (8.3%) malignant thyroid disorders. Definitive management included 129 (38.1%) total thyroidectomies, 70 (20.6%) hemithyroidectomies, 10 (2.9%) subtotal thyroidectomies and 5 (1.5%) near-total thyroidectomies with 125 (36.9%) patients treated non-surgically. The overall complication rate was 11.3%. There were 4 (1.9%) patients with recurrent laryngeal nerve palsy, 16 (7.5%) patients with temporary hypoparathyroidism, 1 (0.5%) patient with paralysis of the external branch of the superior laryngeal nerve and 3 (1.4%) patients with wound hematoma.

CONCLUSION

The rate of complications following thyroidectomy is still high. There is a need for emphasis on comprehensive measures to control the high rate of complications.

LIMITATIONS

Retrospective design and no long-term follow up to monitor late complications.

CONFLICT OF INTEREST

None.