title: Meta-analysis of recurrent laryngeal nerve injury in thyroid surgery with or without intraoperative nerve monitoring.
abstract: Intraoperative nerve monitoring (IONM) aimed at reducing the injuries of recurrent laryngeal nerve during thyroidectomy is controversial. We conducted a meta-analysis to assess the incidence of nerve injuries with or without IONM. Studies published from January 1994 to February 2012 in English language on humans were identified. Heterogeneity of studies was checked by the Higgins test. Summary estimates of predictive values of injury were made using the Mantel-Haenszel test based on the fixed-effects model. Publication bias was assessed by a funnel plot and Egger's method. Eight articles were selected accounting a total of 5257 nerves at risk. IONM revealed a significant impact in preventing transient injuries (positive predictive value = 5% [95% CI: 2-8], negative = 96% [95% CI: 91-100], relative risk = 0.73 [95% CI: 0.54-0.98], p = 0.035), whereas they failed to demonstrate effect on permanent injuries (positive predictive value = 2% [95% CI: 0.6-3.8], negative 99% [95% CI: 97-100], relative risk = 0.73 [95% CI: 0.44-1.23], p = 0.235). This meta-analysis demonstrated the merit of IONM in preventing transient injury during thyroidectomy. No advantage was found in permanent injuries.
authors.affiliation: Department Clinical Sciences and Translational Medicine, Tor Vergata University Hospital, University of Rome Tor Vergata, Italy;
authors.forename: F
authors.initials: F
authors.lastname: Rulli
authors.affiliation: Department Clinical Sciences and Translational Medicine, Tor Vergata University Hospital, University of Rome Tor Vergata, Italy;
authors.forename: V
authors.initials: V
authors.lastname: Ambrogi
authors.affiliation: Department of Surgical Sciences and Human Morphology, University of Insubria, Varese, Italy;
authors.forename: G
authors.initials: G
authors.lastname: Dionigi
authors.affiliation: Department Clinical Sciences and Translational Medicine, Tor Vergata University Hospital, University of Rome Tor Vergata, Italy;
authors.forename: S
authors.initials: S
authors.lastname: Amirhassankhani
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University Hospital, University of Rome Tor Vergata, Italy;
authors.forename: T C
authors.initials: TC
authors.lastname: Mineo
authors.affiliation: Department Clinical Sciences and Translational Medicine, Tor Vergata University Hospital, University of Rome Tor Vergata, Italy;
authors.forename: F
authors.initials: F
authors.lastname: Ottaviani
authors.affiliation: Department of Surgery, Surgery and Abdominal Transplantation Division, Cliniques Universitaires St. Luc, Université Catholique de Louvain, Brussels, Belgium;
authors.forename: A
authors.initials: A
authors.lastname: Buemi
authors.affiliation: Department of Statistical Medicine, Medtronic®, Italy;
authors.forename: P
authors.initials: P
authors.lastname: DI Stefano
authors.affiliation: Department of Surgery, Surgery and Abdominal Transplantation Division, Cliniques Universitaires St. Luc, Université Catholique de Louvain, Brussels, Belgium;
authors.forename: M
authors.initials: M
authors.lastname: Mourad
mesh_terms: D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D016343:Monitoring, Intraoperative; D061226:Recurrent Laryngeal Nerve Injuries / Q000209:etiology* / Q000517:prevention & control; D013965:Thyroidectomy
keywords: Intraoperative neurostimulation; Meta-analysis; Recurrent laryngeal nerve; Thyroid surgery