S. T. Akram1, D. M. Elfenbein2, H. Chen3, D. F. Schneider1, R. S. Sippel1 1University Of Wisconsin School Of Medicine And Public Health,Department Of Surgery,Madison, WI, USA 2University Of California, Irvine School Of Medicine,Department Of Surgery,Irvine, CALIFORNIA, USA 3University Of Alabama – Birmingham School Of Medicine,Department Of Surgery,Birmingham, Alabama, USA
Introduction:
The American Thyroid Association (ATA) has issued specific pre-operative guidelines for patients undergoing thyroidectomy for treatment of their Graves’ disease. Our goal is to determine if compliance with ATA guidelines for thyroidectomy for Graves’ disease is associated with better outcomes.
Methods:
A retrospective review of a prospectively maintained database was performed to identify 228 patients with Graves’ Disease who underwent a total thyroidectomy between August 2007 and May 2015. Data was then extracted including patient demographics and clinical characteristics and treatment-related morbidity. Patients were considered to be in compliance with the ATA guidelines if they were treated pre-operatively with SSKI and were either rendered euthyroid with methimazole (T4<1.5 ng/dl) or if that was not feasible were treated with a β-Blocker. Analysis of these data was performed using Stata v11 statistical software.
Results:
The mean age of all patients in our study was 39 ± 1 years and 82% were female. The majority of patients were treated with methimazole (84%) and β-blockers (54%). All patients underwent a total thyroidectomy, and the mean OR time was 114 ± 3 minutes and mean estimated blood loss (EBL) was 45 ± 7 mL. About one third of patients (36%) had a complication following thyroidectomy. Transient hypocalcemia was the most common complication (27%). At the time of surgery, 52% of all patients were found to be in compliance with the ATA guidelines. Patients that were not prepped according to the ATA guidelines had more intraoperative tachycardia (episodes of heart rate exceeding 120) (0.3 vs. 4.6, p = 0.05), but thankfully had no difference in peak SBP (p = 0.64) or in number of episodes of SBP >180 (p=0.31). ATA prepped and non-prepped patients had similar EBL (45.9 vs. 47.3 mL, p = 0.93), mean OR time (113.1 vs. 117.4 minutes, p = 0.45), and length of stay (0.6 vs. 0.7 days, p = 0.46). ATA prepped and non-prepped patients had similar complication rates, including transient hypocalcemia (29.9% vs. 24.4%, p = 0.40), prolonged hypoparathyroidism (1.0% vs. 3.3%, p = 0.28), hoarse voice/temporary RLN palsy (2.2% vs. 3.1%, p = 0.37), prolonged RLN paralysis (3.1% vs. 2.2%, p = 0.70), hematoma formation (3.13% vs. 0%, p = 0.09), or returning to the OR (2% vs. 1.1%, p = 0.60).
Conclusion:
Our data suggests that compliance with ATA guidelines for thyroidectomy preparation is not a necessary prerequisite for a successful postoperative outcome. While preparation according to the guidelines decreased the frequency of intraoperative tachycardia, it did not impact intraoperative hypertension, OR time, blood loss, or post-operative complications. The use of SSKI and methimazole to prepare patients for thyroidectomy did not improve outcomes at a high volume center.