title: Retrosternal Goiter: 30-Day Morbidity and Mortality in the Transcervical and Transthoracic Approaches.
abstract: Retrosternal goiters pose a significant challenge in determining the indications and appropriate approach for surgical removal while limiting postoperative morbidity and mortality. The objective of this study is to use the National Surgical Quality Improvement Program (NSQIP) database to compare outcomes of transcervical and transthoracic approaches for retrosternal goiter removal and to review the literature regarding the varying indications for the 2 surgical approaches.
  
  
  
  Administrative database analysis.
  
  
  
  NSQIP database.
  
  
  
  The NSQIP database was queried for all cases of retrosternal thyroid: 2716 patients were included, which represents one of the largest data reviews of patients with retrosternal thyroid pathology who underwent surgery. Data were analyzed to examine morbidity and mortality of the cervical and transthoracic approaches.
  
  
  
  Patient demographics and preoperative comorbidities were similar between groups. Patients undergoing a transthoracic approach experienced increased rates of unplanned intubations and need for transfusion and length of stay postoperatively.
  
  
  
  A transthoracic approach is associated with increased rates of several critical postoperative morbidities, and the data indicate the potential of increased overall mortality. Given equivalent retrosternal extension, a transcervical approach should be attempted whenever anatomically possible, regardless of pathology.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, New York, USA mohemmed.khan@mountsinai.org.
authors.forename: Mohemmed N
authors.initials: MN
authors.lastname: Khan
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, New York, USA.
authors.forename: Erden
authors.initials: E
authors.lastname: Goljo
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, New York, USA Department of General Surgery, Mount Sinai Medical Center, New York, New York, USA.
authors.forename: Randall
authors.initials: R
authors.lastname: Owen
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
authors.forename: Richard Chan Woo
authors.initials: RC
authors.lastname: Park
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, New York, USA.
authors.forename: Mike
authors.initials: M
authors.lastname: Yao
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, New York, USA.
authors.forename: Brett A
authors.initials: BA
authors.lastname: Miles
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D006045:Goiter, Substernal / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: substernal goiter; thyroid disease; thyroid neoplasm; thyroid nodule; thyroidectomy