Background: Recurrent laryngeal nerve (RLN) injury, a dreaded complication in thyroid surgery, remains a concern even in the hands of seasoned surgeons. It stands as a significant cause for medical malpractice claims against surgeons. Objective: To assess the Magnitude of RLN injury and associated factors in patients undergoing thyroid surgery at St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia, from May 1st, 2021, to April 30th, 2022. Methods: A facility-based, observational study was conducted at SPHMMC, Addis Ababa, Ethiopia. Data was collected using a structured questionnaire designed with Google Forms. A census sampling approach was used to select the data charts to ensure a comprehensive perspective. This method ensured a representative sample of the population under study, enhancing the reliability of the results. The information was transferred to Excel and then imported into SPSS. Descriptive statistics were employed to summarize the key characteristics within the dataset concisely. Stepwise multiple logistic regression was implemented to explore the potential relationships between the independent and dependent variables. A significance level of p < 0.05 was adopted to identify statistically meaningful results. The findings are presented through a combination of text, tables, and figures. Results: The study included a total of 185 patients, with a mean± SD age of 41.62 ± 12.72 and a median age of 40. Females constituted 78.9% of the participants. The study's key finding is a persistent RLN injury rate of 5.4% (10/185). After adjusting for other covariates, the odds of developing persistent RLN injury were found to be 30 times higher among patients who had central neck dissection than those who had not undergone central neck dissection (AOR=30.0, 95%CI=4.3,211.9, p-value=0.001). However, sex, substernal goiter, histologic finding, preoperative toxicity, extent of thyroidectomy, and identification of RLN intra-operatively were not associated with persistent RLN injury in bivariate logistic regression analysis. Conclusion: This study found a persistent, recurrent laryngeal nerve injury rate of 5.4% in patients undergoing thyroid surgery. Central neck dissection was the only factor significantly associated with an increased risk of recurrent laryngeal nerve injury. These findings suggest minimizing central neck dissection when feasible during thyroid surgery to reduce the risk of this complication.
Published in | Journal of Surgery (Volume 12, Issue 4) |
DOI | 10.11648/j.js.20241204.11 |
Page(s) | 92-98 |
Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
Copyright |
Copyright © The Author(s), 2024. Published by Science Publishing Group |
Thyroid Surgery, Recurrent Laryngeal Nerve Injury, Vocal Cord Paralysis
[1] | Alyahya KA, Alarfaj AA, Alyahya AA, Alnaim AE. Indications and complications for surgical management of thyroid diseases: A single center experience. Ann Med Surg (Lond). 2022; 79: 103980. |
[2] | Asban A, Anue A, Xie R, Chen H. Increasing use of thyroidectomy as definitive treatment for hyperthyroidism. Journal of Surgical Research. 2020; 246: 435-41. |
[3] | Cipolla C, Graceffa G, Calamia S, Fiorentino E, Pantuso G, Vieni S, et al. The value of total thyroidectomy as the definitive treatment for Graves' disease: A single centre experience of 594 cases. J Clin Transl Endocrinol. 2019; 16: 100183. |
[4] | Lukinović J, Bilić M. Overview of Thyroid Surgery Complications. Acta Clin Croat. 2020; 59(Suppl 1): 81-6. |
[5] | Christou N, Mathonnet M. Complications after total thyroidectomy. J Visc Surg. 2013; 150(4): 249-56 |
[6] | Hayward NJ, Grodski S, Yeung M, Johnson WR, Serpell J. Recurrent laryngeal nerve injury in thyroid surgery: a review. ANZ J Surg. 2013; 83(1-2): 15-21. |
[7] | Chandrasekhar SS, Randolph GW, Seidman MD, Rosenfeld RM, Angelos P, Barkmeier-Kraemer J, et al. Clinical practice guideline: improving voice outcomes after thyroid surgery. Otolaryngol Head Neck Surg. 2013; 148(6 Suppl): S1-37. |
[8] | Zakaria HM, Al Awad NA, Al Kreedes AS, Al-Mulhim AM, Al-Sharway MA, Hadi MA, et al. Recurrent laryngeal nerve injury in thyroid surgery. Oman Med J. 2011; 26(1): 34-8. |
[9] | Pardal-Refoyo JL, Parente-Arias P, Arroyo-Domingo MM, Maza-Solano JM, Granell-Navarro J, Martínez-Salazar JM, et al. Recommendations on the use of neuromonitoring in thyroid and parathyroid surgery. Acta Otorrinolaringol Esp (Engl Ed). 2018; 69(4): 231-42. |
[10] | Chawaka HJ, Teshome ZB. The Underreported Postoperative Suffering after Thyroid Surgery: Dysphagia, Dysphonia, and Neck Pain-A Cross-Sectional Study. Anesthesiol Res Pract. 2023; 2023: 1312980. |
[11] | Suga Y, Abebe E. Patterns of Surgically Treated Thyroid Disease: A Two Years Review at St. Paul Hospital Millennium medical Collage, Addis Ababa, Ethiopia. Ethiop J Health Sci. 2020; 30(1): 31-6. |
[12] | Ramos JM, Abate N, Reyes F, Belate W, Mohammed F, Gorgolas M. Thyroid surgery in a district hospital in Southern Ethiopia: experience from a rural center. World J Surg. 2013; 37(7): 1571-3. |
[13] | Aygun N, Kostek M, Unlu MT, Isgor A, Uludag M. Clinical and Anatomical Factors Affecting Recurrent Laryngeal Nerve Paralysis During Thyroidectomy via Intraoperative Nerve Monitorization. Front Surg. 2022; 9: 867948. |
[14] | Biondi B, Kahaly GJ, Robertson RP. Thyroid Dysfunction and Diabetes Mellitus: Two Closely Associated Disorders. Endocr Rev. 2019; 40(3): 789-824. |
[15] | Liu N, Chen B, Li L, Zeng Q, Sheng L, Zhang B, et al. Recurrent Laryngeal Nerve Injury Near the Nerve Entry Point in Total Endoscopic Thyroidectomy: A Retrospective Cohort Study. Cancer Manag Res. 2021; 13: 8979-87. |
[16] | Wondwosen M, Bekele M, Abebe K, Tantu T, Zewdu D. Factors associated with thyroidectomy complications in resource-limited settings: An observational study. International Journal of Surgery Open. 2022; 42: 100468. |
[17] | Alsaleh N, Albaqmi K, Alaqel M. Effectiveness of hemi-thyroidectomy in relieving compressive symptoms in cases with large multi nodular goiter. Annals of Medicine and Surgery. 2021; 63: 102140. |
[18] | Padur AA, Kumar N, Guru A, Badagabettu SN, Shanthakumar SR, Virupakshamurthy MB, et al. Safety and Effectiveness of Total Thyroidectomy and Its Comparison with Subtotal Thyroidectomy and Other Thyroid Surgeries: A Systematic Review. J Thyroid Res. 2016; 2016: 7594615. |
[19] | Addasi N, Fingeret A, Goldner W. Hemithyroidectomy for Thyroid Cancer: A Review. Medicina (Kaunas). 2020; 56(11). |
[20] | Gambardella C, Polistena A, Sanguinetti A, Patrone R, Napolitano S, Esposito D, et al. Unintentional recurrent laryngeal nerve injuries following thyroidectomy: Is it the surgeon who pays the bill? Int J Surg. 2017; 41 Suppl 1: S55-s9. |
[21] | Gunn A, Oyekunle T, Stang M, Kazaure H, Scheri R. Recurrent Laryngeal Nerve Injury After Thyroid Surgery: An Analysis of 11,370 Patients. J Surg Res. 2020; 255: 42-9. |
APA Style
Alemayehu, F., Geletu, Z., Birhanu, W., Berhe, L. Z., Ayalew, Z., et al. (2024). Recurrent Laryngeal Nerve Injury After Thyroid Surgery at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. Journal of Surgery, 12(4), 92-98. https://doi.org/10.11648/j.js.20241204.11
ACS Style
Alemayehu, F.; Geletu, Z.; Birhanu, W.; Berhe, L. Z.; Ayalew, Z., et al. Recurrent Laryngeal Nerve Injury After Thyroid Surgery at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. J. Surg. 2024, 12(4), 92-98. doi: 10.11648/j.js.20241204.11
AMA Style
Alemayehu F, Geletu Z, Birhanu W, Berhe LZ, Ayalew Z, et al. Recurrent Laryngeal Nerve Injury After Thyroid Surgery at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. J Surg. 2024;12(4):92-98. doi: 10.11648/j.js.20241204.11
@article{10.11648/j.js.20241204.11, author = {Fitsum Alemayehu and Zelalem Geletu and Waltengus Birhanu and Lidya Zewdie Berhe and Zekarias Ayalew and Gebeyehu Azibte}, title = {Recurrent Laryngeal Nerve Injury After Thyroid Surgery at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia }, journal = {Journal of Surgery}, volume = {12}, number = {4}, pages = {92-98}, doi = {10.11648/j.js.20241204.11}, url = {https://doi.org/10.11648/j.js.20241204.11}, eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20241204.11}, abstract = {Background: Recurrent laryngeal nerve (RLN) injury, a dreaded complication in thyroid surgery, remains a concern even in the hands of seasoned surgeons. It stands as a significant cause for medical malpractice claims against surgeons. Objective: To assess the Magnitude of RLN injury and associated factors in patients undergoing thyroid surgery at St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia, from May 1st, 2021, to April 30th, 2022. Methods: A facility-based, observational study was conducted at SPHMMC, Addis Ababa, Ethiopia. Data was collected using a structured questionnaire designed with Google Forms. A census sampling approach was used to select the data charts to ensure a comprehensive perspective. This method ensured a representative sample of the population under study, enhancing the reliability of the results. The information was transferred to Excel and then imported into SPSS. Descriptive statistics were employed to summarize the key characteristics within the dataset concisely. Stepwise multiple logistic regression was implemented to explore the potential relationships between the independent and dependent variables. A significance level of p Results: The study included a total of 185 patients, with a mean± SD age of 41.62 ± 12.72 and a median age of 40. Females constituted 78.9% of the participants. The study's key finding is a persistent RLN injury rate of 5.4% (10/185). After adjusting for other covariates, the odds of developing persistent RLN injury were found to be 30 times higher among patients who had central neck dissection than those who had not undergone central neck dissection (AOR=30.0, 95%CI=4.3,211.9, p-value=0.001). However, sex, substernal goiter, histologic finding, preoperative toxicity, extent of thyroidectomy, and identification of RLN intra-operatively were not associated with persistent RLN injury in bivariate logistic regression analysis. Conclusion: This study found a persistent, recurrent laryngeal nerve injury rate of 5.4% in patients undergoing thyroid surgery. Central neck dissection was the only factor significantly associated with an increased risk of recurrent laryngeal nerve injury. These findings suggest minimizing central neck dissection when feasible during thyroid surgery to reduce the risk of this complication. }, year = {2024} }
TY - JOUR T1 - Recurrent Laryngeal Nerve Injury After Thyroid Surgery at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia AU - Fitsum Alemayehu AU - Zelalem Geletu AU - Waltengus Birhanu AU - Lidya Zewdie Berhe AU - Zekarias Ayalew AU - Gebeyehu Azibte Y1 - 2024/07/03 PY - 2024 N1 - https://doi.org/10.11648/j.js.20241204.11 DO - 10.11648/j.js.20241204.11 T2 - Journal of Surgery JF - Journal of Surgery JO - Journal of Surgery SP - 92 EP - 98 PB - Science Publishing Group SN - 2330-0930 UR - https://doi.org/10.11648/j.js.20241204.11 AB - Background: Recurrent laryngeal nerve (RLN) injury, a dreaded complication in thyroid surgery, remains a concern even in the hands of seasoned surgeons. It stands as a significant cause for medical malpractice claims against surgeons. Objective: To assess the Magnitude of RLN injury and associated factors in patients undergoing thyroid surgery at St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia, from May 1st, 2021, to April 30th, 2022. Methods: A facility-based, observational study was conducted at SPHMMC, Addis Ababa, Ethiopia. Data was collected using a structured questionnaire designed with Google Forms. A census sampling approach was used to select the data charts to ensure a comprehensive perspective. This method ensured a representative sample of the population under study, enhancing the reliability of the results. The information was transferred to Excel and then imported into SPSS. Descriptive statistics were employed to summarize the key characteristics within the dataset concisely. Stepwise multiple logistic regression was implemented to explore the potential relationships between the independent and dependent variables. A significance level of p Results: The study included a total of 185 patients, with a mean± SD age of 41.62 ± 12.72 and a median age of 40. Females constituted 78.9% of the participants. The study's key finding is a persistent RLN injury rate of 5.4% (10/185). After adjusting for other covariates, the odds of developing persistent RLN injury were found to be 30 times higher among patients who had central neck dissection than those who had not undergone central neck dissection (AOR=30.0, 95%CI=4.3,211.9, p-value=0.001). However, sex, substernal goiter, histologic finding, preoperative toxicity, extent of thyroidectomy, and identification of RLN intra-operatively were not associated with persistent RLN injury in bivariate logistic regression analysis. Conclusion: This study found a persistent, recurrent laryngeal nerve injury rate of 5.4% in patients undergoing thyroid surgery. Central neck dissection was the only factor significantly associated with an increased risk of recurrent laryngeal nerve injury. These findings suggest minimizing central neck dissection when feasible during thyroid surgery to reduce the risk of this complication. VL - 12 IS - 4 ER -