title: Incidence and risk factors for injuries to the recurrent laryngeal nerve during neck surgery in the moderate-volume setting.
abstract: OBJECTIVE
  Total lobectomy is currently recommended also in benign thyroid disease in order to reduce the risk of goitre recurrence, an approach claimed not to increase post-operative morbidity. The aim of the study was to analyse risk factors for recurrent laryngeal nerve (RLN) palsy during neck surgery, with particular interest in complications after total lobectomy and subtotal resection, respectively.
  
  
  METHODS
  All consecutive patients operated for thyroid and parathyroid diseases at one institution between 1984 and 2011 were prospectively recorded, and 1,322 patients were included. Patients with permanent post-operative RLN palsy were re-examined in 2011.
  
  
  RESULTS
  The risk of permanent RLN palsy after parathyroid surgery was 0.3 %. Patients operated for thyroid cancer had a 5.9 % risk of permanent nerve injury, higher than that of patients with benign thyroid disease (1.4 %; P = 0.029). Independent risk factors for RLN paralysis after benign thyroid surgery were intrathoracic goitre (odds ratio (OR), 3.57; 95 % confidence interval, 1.70-7.48), ipsilateral redo-surgery (OR, 3.64; 1.00-13.28) and total lobectomy (OR, 2.41; 1.05-5.55). At long-time follow-up (median, 10 years), 7 of 12 patients with permanent RLN palsy still suffered moderate or severe symptoms.
  
  
  CONCLUSIONS
  RLN paralysis is an infrequent complication after neck surgery, but with major negative impact on patients' well-being when permanent. Hemithyroidectomy/total thyroidectomy is increasingly preferred over subtotal resection in multinodular goitre. This is supported by an increased risk of RLN injury during redo-surgery for recurrency but should be carefully weighed against individual risk factors for nerve palsy, including surgical experience and volume.
authors.affiliation: Department of Surgery, Ryhov County Hospital, 551 85, Jönköping, Sweden, kalle.landerholm@lj.se.
authors.forename: Kalle
authors.initials: K
authors.lastname: Landerholm
authors.forename: Anna-Maria
authors.initials: AM
authors.lastname: Wasner
authors.forename: Johannes
authors.initials: J
authors.lastname: Järhult
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010279:Parathyroid Diseases / Q000601:surgery*; D016105:Parathyroidectomy; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D061226:Recurrent Laryngeal Nerve Injuries / Q000453:epidemiology*; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy