W. Q. Duong1, A. Grigorian1, D. Elfenbein1, M. Yamamoto1, C. Farzaneh1, K. Rosenbaum2, M. Lekawa1, J. Nahmias1 1University of California, Irvine,Department Of Surgery,Orange, CA, USA 2University of California, Irvine,School Of Medicine,Irvine, CA, USA
Introduction: Conflicting reports exist regarding the benefit of intraoperative nerve monitoring (INM) for patients undergoing thyroidectomy. A recent large systematic review comprised of multiple single and multicenter studies with heterogenous populations failed to show a significant reduction in recurrent laryngeal nerve injury (RLNi) for patients undergoing thyroidectomy. We hypothesized that in a national sample, the risk of RLNi is decreased for patients undergoing neoplasm-related disease (NRD) thyroidectomy with INM compared to those without INM.
Methods: The 2016-2017 ACS-NSQIP Procedure-Targeted Thyroidectomy database was queried for those that underwent thyroidectomy for NRD with and without INM. A multivariable logistic regression model was used to determine risk of RLNi, after controlling for prior neck surgery, gender, age, surgical specialty, operative time>2-hours, central neck dissection and neoplasm type (follicular adenoma, follicular cancer, anaplastic, hurthle cell adenoma, hurthle cell cancer, medullary cancer and papillary cancer).
Results: From 6,942 patients, 4,269 (61.5%) had INM during thyroidectomy. The most common neoplasm type was papillary cancer (55.5%). Patients with INM had a similar rate of RLNi compared to those without INM (5.7% vs. 6.7%, p=0.118). However, after adjusting for covariates, INM was associated with a decreased risk of severe-RLNi (OR 0.23, 0.06-0.91, p=0.036) but not mild-RLNi (p=0.16). The rates of pneumonia (25.0% vs. 0.8%, p<0.001), respiratory failure (40% vs. 0.1%, p<0.001), unplanned intubation (40% vs. 0.2%, p<0.001) and 30-day readmission (30.0% vs. 2.7%, p<0.001) were all significantly higher in those with severe-RLNi, compared to those without RLNi.
Conclusion: INM is associated with a nearly 80% associated risk reduction of severe RLNi during thyroidectomy for NRD. Future prospective evaluation and if this is confirmed than this group of patients should undergo INM to reduce the risk of RLNi and its associated morbidity including pneumonia, unplanned intubation, respiratory failure, and 30-day readmission.
