갑상선 수술 후 의인성 성대 마비의 위험 요인: 10년간의 단일 기관 경험
Risk Factors for Iatrogenic Vocal Fold Palsy during Thyroid Surgery: A Single Institutional Experience Over 10 Years
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Background and Objectives Recurrent laryngeal nerve (RLN) palsy is a critical complicationof thyroid surgery. The aim of this study was to investigate the incidence of iatrogenic temporaryor permanent RLN palsy and to determine the surgeon’s experience factor for iatrogenicRLN palsy. Subjects and Method We retrospectively reviewed 3404 patients, who underwent thyroidectomybetween 2010 and 2019, to identify the surgeon’s experience factor for iatrogenic RLNpalsy. Information about patient demographics, surgeon factor, whether or not intraoperativeneuromonitoring (IONM) were used, and the postoperative status of RLN were collected. Theincidence of RLN injury was analyzed according to the surgeon experience, surgery for thyroidcancer, effect of IONM and the extent of surgery. Results A total of 4479 RLNs were at risk in 3094 thyroidectomies in this study. There were34 (1.10%) postoperative vocal cord palsy (VCP) cases after thyroidectomy. All patients withRLN palsy showed a unilateral type. VCP was temporary in 26 (0.84%) cases and permanentin 8 (0.26%) cases. Using the nerve at risk (NAR) method, we found that there were 34 NARpalsy out of the total (4479) NAR (0.76%), 26 NAR temporary palsy (0.58%), and 8 NAR permanentpalsy (0.18%). The mean recovery time after temporary VCP ranged between 2-180days (50.6 days in average). The incidence of permanent RLN injury was higher in surgeryconducted by less experienced surgeon (1.71% in less experienced vs. 0.05% in experiencedsurgeon, odds ratio 35.991, p<0.001). Application of IONM had no impact on incidence of iatrogenicRLN injury. Conclusion The present study demonstrated that less experienced surgeon is associated withan increased risk of iatrogenic permanent RLN palsy after thyroidectomy.
Abstract
Background and Objectives Recurrent laryngeal nerve (RLN) palsy is a critical complicationof thyroid surgery. The aim of this study was to investigate the incidence of iatrogenic temporaryor permanent RLN palsy and to determine the surgeon’s experience factor for iatrogenicRLN palsy. Subjects and Method We retrospectively reviewed 3404 patients, who underwent thyroidectomybetween 2010 and 2019, to identify the surgeon’s experience factor for iatrogenic RLNpalsy. Information about patient demographics, surgeon factor, whether or not intraoperativeneuromonitoring (IONM) were used, and the postoperative status of RLN were collected. Theincidence of RLN injury was analyzed according to the surgeon experience, surgery for thyroidcancer, effect of IONM and the extent of surgery. Results A total of 4479 RLNs were at risk in 3094 thyroidectomies in this study. There were34 (1.10%) postoperative vocal cord palsy (VCP) cases after thyroidectomy. All patients withRLN palsy showed a unilateral type. VCP was temporary in 26 (0.84%) cases and permanentin 8 (0.26%) cases. Using the nerve at risk (NAR) method, we found that there were 34 NARpalsy out of the total (4479) NAR (0.76%), 26 NAR temporary palsy (0.58%), and 8 NAR permanentpalsy (0.18%). The mean recovery time after temporary VCP ranged between 2-180days (50.6 days in average). The incidence of permanent RLN injury was higher in surgeryconducted by less experienced surgeon (1.71% in less experienced vs. 0.05% in experiencedsurgeon, odds ratio 35.991, p<0.001). Application of IONM had no impact on incidence of iatrogenicRLN injury. Conclusion The present study demonstrated that less experienced surgeon is associated withan increased risk of iatrogenic permanent RLN palsy after thyroidectomy.
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