D. I. Maher1, B. Hii1, M. Yeung1, S. Grodski1,2, J. W. Serpell1,2, J. C. Lee1,2 1Alfred Hospital,Monash University Endocrine Surgery Unit,Melbourne, VIC, Australia 2Monash University,Department Of Surgery,Melbourne, VIC, Australia
Introduction: While modern thyroidectomy originated over 150 years ago in 19th century Europe, the procedure has undergone a major evolution over the last century, and transformed from a procedure associated with high mortality to near zero mortality in modern surgical practice. Nonetheless, surgeons must always strive to improve patient care and reduce mortality and morbidity. Using historical records and analysis of contemporaneously collected data, this study aimed to compare the practice and outcomes of thyroid surgery at a Melbourne tertiary institution during two periods, 50 years apart.
Methods: “The Alfred Hospital Clinical Reports” recorded areas of work being undertaken on the wards and in laboratories of the hospital, including all cases of surgically managed thyroid disease from 1946 – 59 (14-year period). These historical cases were compared to contemporary cases of total thyroidectomy during a 10-year period from 2007 – 16, also at the Alfred Hospital. Data from contemporary cases were recorded in the Monash University Endocrine Surgery Unit (MUESU) database. Cases in the historical and contemporary groups were compared and evaluated for surgery indication and post-operative outcomes including rates of nerve palsy, infection, hemorrhage and mortality.
Results: There were 746 patients in the historical cohort (mean age 53, 87 % female) and 787 patients in the contemporary cohort (mean age 52, 80 % female). Operative complications were studied and recorded in 680 of the historical patients. The most common indication for thyroidectomy in both groups was non-toxic nodular goiter (56 % of historical cases, 35 % of contemporary cases). In the contemporary group, a significantly higher proportion of patients were diagnosed with malignancy of the thyroid compared to the historical group (27 % vs. 8 %; p < 0.001). The historical data documented 36 (5.3 %) cases of recurrent laryngeal nerve palsy (RLNP) following surgery compared to 27 (3.4 %) cases in the contemporary group (p = 0.09). Permanent nerve palsy was noted to be significantly higher in the historical group (4.6 % vs. 0.6 %, p < 0.001), which also had a higher rate of bilateral palsy (8 cases vs. 3 cases p = 0.13). There were no mortalities in the contemporary cohort. The historical data detailed three deaths (0.44 %); two of the deaths were due to thyrotoxic crisis, while the third patient died from post-operative respiratory complications.
Conclusions: This paper uniquely compares the indications and outcomes of thyroid surgery in two cohorts of patients separated by a 50-year period. While non-toxic goitre remains the most common indication for thyroidectomy, an increased number thyroid malignancies were diagnosed in the contemporary group. As expected, morbidity and mortality after thyroidectomy has improved as thyroid surgery has progressed over the past 50 years. Notably, there were fewer cases of death, permanent palsy and bilateral palsy in the contemporary group.