Objective: Total thyroidectomy (TTx) has an overall complication rate up to 6%. Bilateral vocal cord injury during TTx may result in life-threatening airway compromise necessitating tracheostomy. This study examines potential risk factors for tracheostomy after TTx.
Methods: A cross-sectional analysis was performed using the Nationwide Inpatient Sample (2006-2011) of patients who underwent TTx. Patient demographics, co-morbidities, and perioperative outcomes including need for tracheostomy were evaluated. Univariate and logistic regression analyses identified characteristics independently predictive of tracheostomy after TTx.
Results: Of 219,720 patients, tracheostomy was performed in 1.2% (n=2745). More men (35.7% vs. 21.5%, p<0.01), blacks (24.1% vs.13.6%, p<0.01) and Hispanics (15.4% vs. 9.7%, p<0.01) underwent tracheostomy. Postoperatively, tracheostomy patients experienced more hemorrhage (15.5% vs 1.5%, p<0.01), hypoparathyroidism (6.8% vs. 1.4%) and death (5.4% vs 0.2%, p<0.01). Older age (OR1.03;CI 1.02-1.03), male sex (OR1.72;CI 1.55-1.91), thyroid cancer (OR1.24;CI 1.12-1.37), heart failure (OR2.92;CI 2.49-3.43), obesity (OR1.60;CI 1.41-1.82), substernal thyroidectomy (OR1.39;CI 1.21-1.60) postoperative hematoma (OR1.61;CI 1.21-2.15), wound complication (OR10.19;CI 7.67-13.55), unilateral (OR6.55;CI 5.43-7.91) and bilateral vocal cord paralysis (OR203.73;CI 170.27-243.77), substernal thyroidectomy (OR1.388;CI1.208-1.594), and hypoparathyroidism (OR 3.59; CI 2.89-4.44) were associated with tracheostomy. TTx at high volume centers (top quintile) had lower risk for tracheostomy (OR0.65; CI 0.57-0.74).
Conclusions: Clinical and postoperative factors associated with tracheostomy after TTx include older age, men, obesity, thyroid cancer, hematoma, wound complications, vocal cord paralysis, substernal thyroidectomy, and hypoparathyroidism. Patients undergoing TTx at high volume centers may be at lower risk of tracheostomy.
