Endocrine Abstracts

Background: Obesity is a major public health issue frequently associated with increased complication rates after elective general surgery. Previous reports on complications after thyroid surgery in obese patients were performed on selected cohorts. In this study, we sought to explore the relationship between Body Mass Index (BMI) and postoperative morbidity after thyroid surgery in a large cohort of consecutive patients.

Materials and Methods: A single-centre retrospective analysis was conducted on patients who underwent total or partial thyroidectomy with or without central or lateral compartment dissection at a tertiary referral endocrine surgery unit between January 1st 2020 and October 31st 2021. Clinical and postoperative data was collected including postoperative haemorrhage (PH), severe hypocalcemia (<7,5 mg/dL at day 1) (PSH), recurrent laryngeal nerve palsy (RLNP) and wound infection (WI) rates along with surgery duration (SD) and postoperative stay (POS), which were treated as outcome measures. Univariate and multivariate linear and logistic regression analyses were performed and results were adjusted for confounders relevant to each outcome measure.

Results: A total of 656 consecutive patients were included (77,7% male; 22,3% female), with a median BMI of 24,8 Kg/m2 [IQR 22,3 – 27,5]. The BMI distribution among patients was 51,8% lower than 25 kg/m2, 34,3% between 25 and 30 kg/m2 and 13,9% above 30 kg/m2. Total thyroidectomy was performed in 90,1% of cases while central and lateral compartment dissection was performed on 11,4% and 2% of patients, respectively. Thirtyone patients (4,7%) underwent additional parathyroidectomy for associated primary hyperparathyroidism. Postoperative hemorrhage PH, PSH, RLNP, and WI rates were 0,6%, 19,5%, 3,8%, and 1,2%, respectively, with a median POS of 2 days [IQR: 2-2]. When adjusted for relevant confounders BMI was not found to be a predictor of PH, RLNP, WI, SD and POS (all p>0.05). However, when adjusted for central compartment dissection, thyroidectomy extension, age, gender, parathyroidectomy, Graves’ disease and chronic thyroiditis, BMI was found to be an independent predictor of PSH (OR 0,93; P = 0.06).

Conclusions: This study found that higher BMI values are not associated with an increased rate of major complications after thyroid surgery. Additionally, higher BMI values are independently associated with decreased rates of PSH. The protective role of BMI should be thoroughly investigated due to its potential value in tailoring preoperative calcium and vitamin D supplementation.