title: Is it possible to limit the risks of thyroid surgery?
abstract: OBJECTIVE
  Inferior laryngeal nerve (ILN) palsy and hypocalcemia remain the two most frequent major complications after thyroid surgery. Their occurrences may be explained by the influence of factors related to the patient, the surgical procedure, thyroid pathology, or the surgeon's technique. This study aims To assess whether systematically following a rigorous surgical technique during thyroidectomy affects postoperative complications and long-term patient recovery.
  
  
  METHODS
  We conducted a multicenter, cross-sectional study of prospectively collected data in five high-volume referral centers enrolling all patients who underwent thyroid surgery between April 2008 and December 2009. Inferior laryngeal nerve (ILN) palsy and hypocalcemia were systematically assessed during hospitalization based on objective criteria. A six-month follow-up was conducted in cases of early complications. Multivariate regression models were computed to quantify their relationship with potential risk factors.
  
  
  RESULTS
  A total of 3574 thyroid procedures were completed. Non-visualization of the ILN during dissection and a large thyroid mass were major risk factors for permanent ILN palsy (OR, 4.17 and 2.61, p<0.01) and persistent complications after initial injury (OR, 4.17 and 2.42, p<0.05). The presence of thyroiditis on the surgical specimen was an independent risk factor for permanent hypoparathyroidism and poor recovery after initial dysfunction (OR, 1.76 and 1.88, p<0.05).
  
  
  CONCLUSIONS
  Thorough meticulous technique in thyroid surgery is a determinant of ILN function but fails to prevent persistent hypoparathyroidism.
authors.affiliation: Hospices civils de Lyon, Centre hospitalier Lyon-Sud, Service de chirurgie générale et endocrinienne, Pierre-Bénite, F-69495, France.
authors.forename: R
authors.initials: R
authors.lastname: Daher
authors.affiliation: Hospices civils de Lyon, Centre hospitalier Lyon-Sud, Service de chirurgie générale et endocrinienne, Pierre-Bénite, F-69495, France. Electronic address: jean-christophe.lifante@chu-lyon.fr.
authors.forename: J-C
authors.initials: JC
authors.lastname: Lifante
authors.affiliation: Hospices civils de Lyon, Hôpital Édouard-Herriot, Service d'hygiène, épidémiologie et prévention, Lyon, F-6943, France; Université de Lyon 1, Laboratoire de biométrie et biologie évolutive, Lyon, F-69373, France; CNRS, UMR 5558, Laboratoire de biométrie et biologie évolutive, Lyon, F-69373, France.
authors.forename: N
authors.initials: N
authors.lastname: Voirin
authors.affiliation: Hospices civils de Lyon, Centre hospitalier Lyon-Sud, Service de chirurgie générale et endocrinienne, Pierre-Bénite, F-69495, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Peix
authors.affiliation: Hospices civils de Lyon, Pôle information médicale évaluation recherche, Lyon, F-69003; Université de Lyon, EA Santé-Individu-Société 4129, Lyon, F-69002, France.
authors.forename: C
authors.initials: C
authors.lastname: Colin
authors.affiliation: Department of Endocrine Surgery, Poitiers University, Jean-Bernard Hospital, 86021-Poitiers, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Kraimps
authors.affiliation: Assistance publique-Hôpitaux de Paris, Hôpital la Pitié-Salpêtrière, Service de chirurgie générale, viscérale et endocrinienne, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Menegaux
authors.affiliation: CHRU de Lille, Chirurgie générale et endocrinienne, Lille, 59000, France; Université Lille-Nord de France, INSERM, UMR 859, Lille, 59000, France.
authors.forename: F
authors.initials: F
authors.lastname: Pattou
authors.affiliation: Assistance publique-Hôpitaux de Marseille, CHU la Timone-Adulte, France.
authors.forename: F
authors.initials: F
authors.lastname: Sebag
authors.affiliation: Hospices civils de Lyon, Pôle information médicale évaluation recherche, Lyon, F-69003; Université de Lyon, EA Santé-Individu-Société 4129, Lyon, F-69002, France.
authors.forename: S
authors.initials: S
authors.lastname: Touzet
authors.affiliation: Hospices civils de Lyon, Pôle information médicale évaluation recherche, Lyon, F-69003; Université de Lyon, EA Santé-Individu-Société 4129, Lyon, F-69002, France.
authors.forename: S
authors.initials: S
authors.lastname: Bourdy
authors.affiliation: Hospices civils de Lyon, Pôle information médicale évaluation recherche, Lyon, F-69003; Center for Surgery and Public Health, Brigham and Women's Hospital - Harvard Medical School, Boston, MA, USA; Université de Lyon, EA Santé-Individu-Société 4129, Lyon, F-69002, France.
authors.forename: A
authors.initials: A
authors.lastname: Duclos
mesh_terms: D003389:Cranial Nerve Diseases / Q000453:epidemiology / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D005602:France; D006042:Goiter / Q000150:complications / Q000473:pathology; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology; D007011:Hypoparathyroidism / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012009:Recurrent Laryngeal Nerve; D012307:Risk Factors; D013959:Thyroid Diseases / Q000601:surgery*; D013961:Thyroid Gland / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods*; D013966:Thyroiditis / Q000150:complications
keywords: Hypoparathyroidism; Outcome; Recurrent laryngeal nerve palsy; Surgery; Thyroid; à venir