Surgical Risk after Unilateral Lobectomy Versus Total Thyroidectomy: A Review of 47,434 Patients

Background: We reviewed the 2005-2012 ACS-NSQIP databases to evaluate factors associated with adverse events (AE) after unilateral thyroid lobectomy (UL) and total thyroidectomy (TT). Methods: All unilateral lobectomies and total thyroidectomies performed from 2005 to 2012 were identified for analysis. The cohort was characterized with respect to preoperative and demographic characteristics, complications, reoperation, and mortality. Results: 47,434 patients were identified, of which 17,584 underwent unilateral lobectomy and 29,850 underwent total thyroidectomy. On multivariable regression analysis, UL was associated with a 2.786 greater risk of returning to the OR, and a 1.377 risk of surgical complications. The increased risk of return to the OR was eliminated when controlling for patients returning to the OR for completion thyroidectomy after UL. Conclusion: NSQIP is the only dataset that is able to discern between unilateral lobectomy and total thyroidectomy to make viable comparisons in outcomes. The NSQIP dataset may be imperfect, as pertinent details of chemotherapy and radiation, and procedure-specific complications, including recurrent laryngeal nerve palsy and hypocalcemia, are not tracked. In spite of this, our findings suggest avenues for improvement in the care of thyroidectomy patients, and suggest directions for a thyroidectomy-specific outcomes database.