Z. F. Khan1, G. A. Rubio1, A. R. Marcadis1, T. M. Vaghaiwalla1, J. C. Farra1, J. I. Lew1 1University Of Miami Miller School Of Medicine,Division Of Endocrine Surgery, DeWitt Daughtry Family Department Of Surgery,Miami, FL, USA
Introduction: Permanent hypoparathyroidism is a well-recognized complication of total thyroidectomy that may acutely manifest postoperatively with muscle spasms/tetany, paresthesias, and seizures. An established procedure, parathyroid autotransplantation (PAT) can successfully prevent permanent hypoparathyroidism due to inadvertently resected or devascularized parathyroid tissue. This study examines the independent patient characteristics and postoperative complications associated with those undergoing PAT after total thyroidectomy.
Methods: A retrospective cross-sectional analysis was performed using the Nationwide Inpatient Sample (NIS) database from 2006-2011 to identify surgical patients hospitalized for total thyroidectomy that did or did not undergo PAT. Characteristics including co-morbidities and postoperative complications were measured. Univariate and logistical regression analyses were conducted to identify characteristics that were independently associated with patients that underwent PAT. Data were analyzed using two-tailed Chi-square and t-tests.
Results:Of 219,584 admitted patients who had total thyroidectomy, 14,521 (6.7%) also underwent PAT. Patients in the PAT group had fewer comorbidities including DM, HTN, CHF, chronic lung disease (12.5% vs 15.1%, 37.1% vs 39.9%, 1.5% vs 2.1%, 11% vs 12%, respectively, p<0.01) and fewer cardiac complications including stroke and MI (0% vs 0.2% and 0.1% vs 0.2% , respectively, p<0.01). However, the autotransplanted group had higher rates of renal failure (2.7% vs 2.1%, p<0.01) and thyroid malignancy (55.4% vs 43.1%, p<0.01) compared to those not autotransplanted. The PAT group also had higher incidence of wound complications including SSI and seroma (2.6% vs 2.1%; 0.2% vs 0.1%; 0.2% vs 0.1%, p<0.01, respectively), unilateral vocal cord paralysis (2.4% vs 1.6%, p<0.01), substernal thyroidectomy (8.7% vs 7.5%, p<0.01) and in-hospital death (1.6% vs 0.3%, p<0.01). Immediate hypoparathyroidism (3.2% vs 1.3%, p<0.01), hypocalcemia (15% vs 8.6%, p<0.01), and tetany (0.3% vs 0.1%, p<0.01) were all associated with PAT patients as well. On multivariate analysis, renal failure (2.246 OR; 95% CI 1.448-3.485), and elective procedures (OR 1.744; 95% CI 1.422-2.129) were associated with increased odds of undergoing PAT during hospitalization for total thyroidectomy.
Conclusion:Although a known preventative measure for permanent hypoparathyroidism, PAT is associated with higher rates of postoperative complications. Patients with fewer comorbidities who undergo PAT experience higher rates of wound complications, hypoparathyroidism, hypocalcemia and tetany. Acute severity of postoperative hypoparathyroidism may further contribute to higher rate of in-hospital death in these PAT patients. PAT should not be routinely performed and utilized only in select patients with suspected compromised parathyroid function after total thyroidectomy