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Researchers identified a range of variables throughout thyroidectomy that are associated with increased nerve injury risk.
Among patients undergoing thyroidectomy, larger lesions that require more extensive resection and drain placement are associated with higher rates of nerve injury.
Ryland Neal Spence, BA, and colleagues used a procedure-specific thyroidectomy database to assess recurrent laryngeal nerve injury or dysfunction and its association with 18 perioperative factors. The analysis included 31,605 patients.
Regarding preoperative variables, surgical indication, T stage, nodal status, M stage, biopsy result, neoplasm, neoplasm type, and multifocality were all significantly associated with higher nerve injury or dysfunction. Reported ORs included 0.95 for clinical toxicity, 1.16 for neoplasm, and 2.33 for M stage.
Intraoperative factors, neck dissection, and laryngeal nerve monitoring were significantly associated with injury or dysfunction. During neck dissection, the risk of injury was higher for patients, whereas surgeries using laryngeal nerve monitoring reduced the likelihood of injury. ORs were 1.31 for neck dissection and 0.89 for nerve monitoring.
All available post-operative factors were significantly positively associated with RLN injury or dysfunction, Spence and colleagues found, including post-operative hypocalcemia, clinically severe hypocalcemia, neck hematoma/bleeding, and drain use (P<0.001 for all).
“Use of nerve monitoring is the only measured intraoperative factor protective against [recurrent laryngeal nerve injury] and should be considered in all cases, but especially in those which require more extensive resection,” the researchers noted.
