Comparison of different thyroid surgical procedures and their outcomes/complications for benign disease in relation to expertise of the surgeon in a public hospital of a developing country over 2 decades

Objective: To compare the frequency of postoperative complications with
thyroid surgical procedures and the expertise of the surgeon. Design:
Retrospective cross-sectional study from 1999 to 2018. Setting: A public
sector tertiary care teaching hospital. Participants and methods: Patients
undergoing thyroid surgery (lobectomy with isthmusectomy, subtotal
thyroidectomy (STT), near total thyroidectomy (NTT), or total
thyroidectomy (TT)) were included. Expertise level 1, 2 and 3 (L1, L2, L3)
of the surgeon was based on years of experience or number of thyroid
surgeries to their credit. Primary and Secondary Outcome Measures:
Postoperative complications (hypocalcemia, recurrent laryngeal nerve (RLN)
damage, airway obstruction, hemorrhage and mortality) were measured
against type of thyroid surgery and expertise of surgeon. Results: 833
thyroid surgeries were performed on 695 (83.43%) females and 138 (16.57%)
males. 502 (60.26%) STT, 228 (27.37%) TT, 61 (7.32%) NTT, 42 (5.04%)
lobectomies with isthmusectomies were performed, with LI, 2, and 3
surgeons performing 21.25%, 45.74% and 33.01%, respectively. L1, 2 and 3
surgeons caused 49.47%, 33.45% and 17.08% of adverse events respectively.
The permanent hypocalcemia, RLN damage and mortality were significantly
(p<0.05) more common in surgeries performed by L1 compared with L2
and L3.  Transient and permanent hypocalcemia, transient and
permanent RLN damage and mortality were significantly (p<0.01) more
common for total thyroidectomy compared to subtotal thyroidectomy.
Conclusion: Minimizing the occurrence of complications like permanent
hypocalcemia, RLN damage and mortality, expertise of the surgeon and
anticipated difficulty of the procedure needs to be taken into account
while selecting a thyroid procedure. Keywords: Thyroid surgery, Total
thyroidectomy, Subtotal thyroidectomy, near total thyroidectomy, Lobectomy
with isthmusectomy, hypoparathyroidism, hypocalcemia, recurrent laryngeal
nerve, postoperative complications