Preoperative predictors of sternotomy need in mediastinal goiter management.
BACKGROUND
The objective of this study was to identify the preoperative risk factors for patients in need of a sternotomy in the management of mediastinal goiters in order to provide better preoperative planning and patient consent.


METHODS
We analyzed 98 patients who underwent surgery for mediastinal goiters (goiters extending below the thoracic inlet > or =3 cm with the neck in hyperextension) between 1995 and 2008. Twelve (12.2%) of the patients required a sternotomy. The patients' features were analyzed by the surgical approach performed. Logistic regression analysis was used to study which variables were influencing the surgical strategy. The receiver operating characteristic (ROC) curves were designed when appropriate.


RESULTS
The analysis disclosed the following risk factors: radiologic extension of mediastinal goiters below the aortic arch (odds ratio [OR] = 32.87; 95% confidence interval [CI] = 4.04-267.12; p < .0001); posterior mediastinum involvement for mediastinal goiters with subaortic extension (OR = 7.2; 95% CI = 1.52-34.14; p = .0244); history of mediastinal goiters before surgery (for mediastinal goiters aged >160 months: OR = 22.8; 95% CI = 5.28-98.53; p < .0001).


CONCLUSIONS
Sternotomy need for mediastinal goiter removal can be predicted; in such cases surgeons should not hesitate to perform it for minimizing complications.
Casella
Claudio
C
Department of Medical & Surgical Sciences, First Division of General Surgery, University of Brescia, Italy.
Pata
Giacomo
G
Cappelli
Carlo
C
Salerni
Bruno
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006045:Goiter, Substernal / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010149:Postoperative Pain / Q000503:physiopathology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D056346:Sternotomy / Q000009:adverse effects / Q000379:methods*; D013965:Thyroidectomy / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*