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© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Background: Surgical treatment of Graves’ disease (GD) has a potentially increased incidence of postoperative hypoparathyroidism, recurrent laryngeal nerve palsy (RLNP) and bleeding. The aim of this study was to evaluate the current extent of surgery for the treatment of GD and its safety as a short-term outcome. Methods: Patients who underwent thyroid resection for GD were identified from the prospective StuDoQ/Thyroid registry. Patient data were retrospectively analyzed regarding demographics, surgical procedures and perioperative outcomes. Statistics were performed with Student’s t-test or Fisher’s exact test and multivariate Cox regression analysis. The level of statistical significance was set at p < 0.05. Results: A total of 1808 patients with GD with a median age of 44 (range 14–85) years were enrolled in a 25-month period by 78 departments, of which 35.7% (n = 645) had an endocrine orbitopathy and 0.1% (n = 6) had thyrotoxic crisis. Conventional open surgery was used in 98.6% of cases and minimally invasive or remote-access approaches were used in 1.4%. Total thyroidectomy was performed in 93.4% of cases (n = 1688). Intraoperative neuromonitoring (IONM) was used in 98.9% (n = 1789) of procedures. In 98.3% (n = 1777) at least one parathyroid gland was visualized and in 20.7% (n = 375) parathyroids were autografted. The rates of unilateral and bilateral transient RLNP were 3.9% (n = 134/3429 nerves at risk) and 0.1% (n = 4/3429 NAR). The rates of transient RLNP tended to be higher when intermittent IONM was used compared to continuous IONM (4.1% vs. 3.4%, p < 0.059). The rate of transient postoperative hypoparathyroidism was overall 29% (n = 525/1808). Multivariate analysis revealed fewer than 300 thyroid resections and fewer than 15 thyroid resections for GD per year, male sex, BMI > 30, autotransplantation of parathyroid glands and previous bilateral thyroid surgery as independent risk factors for postoperative temporary hypoparathyroidism. Reoperations for bleeding (1.3%) were rare. Conclusion: Total thyroidectomy with IONM is safe and currently the most common surgical therapy for GD in Germany. Postoperative hypoparathyroidism is the major complication which should be focused on.

Details

Title
Short-Term Outcomes of Surgery for Graves’ Disease in Germany
Author
Maurer, Elisabeth 1 ; Vorländer, Christian 2 ; Zielke, Andreas 3 ; Dotzenrath, Cornelia 4 ; Moritz von Frankenberg 5 ; Köhler, Hinrich 6   VIAFID ORCID Logo  ; Lorenz, Kerstin 7   VIAFID ORCID Logo  ; Weber, Theresia 8 ; Jähne, Joachim 9 ; Hammer, Antonia 10 ; Böttcher, Knut A 11 ; Schwarz, Katharina 12 ; Klinger, Carsten 13 ; Buhr, Heinz J 13 ; Bartsch, Detlef K 1 

 Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg Baldingerstrasse, 35043 Marburg, Germany; [email protected] 
 Department of Endocrine Surgery, Bürgerhospital Frankfurt/Main, 60318 Frankfurt am Main, Germany; [email protected] 
 Department of Endocrine Surgery, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany; [email protected] 
 Department of Endocrine Surgery, Helios Universityhospital Wuppertal, 42283 Wuppertal, Germany; [email protected] 
 Department of Surgery, Hospital Salem-Heidelberg, 69121 Heidelberg, Germany; [email protected] 
 Department of General Surgery, Herzogin Elisabeth Hospital Braunschweig, 38124 Braunschweig, Germany; [email protected] 
 Department of Visceral, Vascular and Endocrine Surgery, University Medical Center Halle, 06120 Halle, Germany; [email protected] 
 Department of Endocrine Surgery, Katholisches Klinikum Mainz, 55131 Mainz, Germany; [email protected] 
 Department of General and Visceral Surgery, Diakovere Henriettenstift Hannover, 30171 Hannover, Germany; [email protected] 
10  Department of Endocrine Surgery, DKD Helios Clinic Wiesbaden, 65191 Wiesbaden, Germany; [email protected] 
11  Department of General and Visceral Surgery, Diakonissen Hospital Mannheim, 68163 Mannheim, Germany; [email protected] 
12  Department of Endocrine Surgery, Lukas Hospital GmbH Neuss, 41464 Neuss, Germany; [email protected] 
13  German Society of General and Visceral Surgery, 10117 Berlin, Germany; [email protected] (C.K.); [email protected] (H.J.B.) 
First page
4014
Publication year
2020
Publication date
2020
Publisher
MDPI AG
e-ISSN
20770383
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2641067829
Copyright
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.