title: The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients.
abstract: BACKGROUND
  Limited information exists about risk factors for postoperative hypoparathyroidism after bilateral thyroid surgery.
  
  
  METHODS
  Between January 1 and December 31, 1998, bilateral thyroid surgery was performed on 5846 patients for benign and malignant thyroid disease. Data were prospectively collected by questionnaires from 45 hospitals. A logistic regression model was used to determine independent risk factors.
  
  
  RESULTS
  The overall incidence of transient and permanent hypoparathyroidism was 7.3% and 1.5%, respectively. On logistic regression analysis, total thyroidectomy (odds ratio [OR], 4.7), female gender (OR, 1.9), Graves' disease (OR, 1.9), recurrent goiter (OR, 1.7), and bilateral central ligation of the inferior thyroid artery (OR, 1.7) constituted independent risk factors for transient hypoparathyroidism. When the multivariate analysis was confined to permanent hypoparathyroidism, total thyroidectomy (OR, 11.4), bilateral central (OR, 5.0) and peripheral (OR, 2.0) ligation of the inferior thyroid artery, identification and preservation of no or only a single parathyroid gland (OR, 4.1), and Graves' disease (OR, 2.4) emerged as independent risk factors.
  
  
  CONCLUSIONS
  Extent of resection and surgical technique had a greater impact on the rates of permanent postoperative hypoparathyroidism than thyroid pathologic condition. In bilateral thyroid surgery, peripheral ligation of the inferior thyroid artery at the thyroid capsule should be favored over central ligation, and at least 2 parathyroid glands should be identified and preserved. High-risk procedures, such as total thyroidectomy and Graves' disease, require special surgical training and expertise.
authors.affiliation: Department of General Surgery, Albert-Ludwigs University Freiburg, Hugstetter Strasse 55, D-79106 Freiburg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Thomusch
authors.forename: Andreas
authors.initials: A
authors.lastname: Machens
authors.forename: Carsten
authors.initials: C
authors.lastname: Sekulla
authors.forename: Jörg
authors.initials: J
authors.lastname: Ukkat
authors.forename: Michael
authors.initials: M
authors.lastname: Brauckhoff
authors.forename: Henning
authors.initials: H
authors.lastname: Dralle
mesh_terms: D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data; D006042:Goiter / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D007011:Hypoparathyroidism / Q000453:epidemiology* / Q000601:surgery*; D008026:Ligation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010280:Parathyroid Glands / Q000637:transplantation; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D013514:Surgical Procedures, Operative; D013961:Thyroid Gland / Q000098:blood supply / Q000601:surgery; D014182:Transplantation, Autologous