EXPERIENCE IN A SPECIALIST THYROID-SURGERY UNIT - A DEMOGRAPHIC-STUDY, SURGICAL COMPLICATIONS, AND OUTCOME

Objective: To present a demographic study of thyroid diseases and thyr oid surgical activity, to analyse the results of one department that h as specialised in thyroid surgery during an Ii-year period, and to try to define those groups of patients at increased risk of complications and untoward sequelae. Design: Retrospective study. Setting: Danish r egional university hospital. Subjects: The total series comprised 1099 consecutive patients who were operated on for benign goitre during an Ii-year period. The demographic series comprised a subgroup of 933 pa tients with goitres from the defined catchment area composed of five m unicipalities. Main outcome measures: Annual number of operations for goitre, waiting time to operation, incidence of complications, and seq uelae. Results: In the demographic study the number of patients operat ed on for benign thyroid diseases declined from about 50 cases to abou t 25 cases/100000 inhabitants during the study period. At the same tim e the average waiting time between consultation and operation increase d from 5-33 weeks. In the total series (n = 1099) 18 patients develope d temporary unilateral vocal cord paralysis (2%), and 8 developed perm anent paralysis (0.7%). There were no bilateral vocal cord paralyses. 7 patients developed temporary postoperative hypocalcaemia (0.6%), and an additional 8 patients (0.7%) developed permanent hypocalcaemia. 5 patients developed wound haematomas (0.5%), and 3 had wound infections (0.3%). A total of 16 patients (1.5%) had a permanent complication in the form of nerve injury or damage to the parathyroid glands. The rat es of postoperative complications were significantly higher among pati ents who had two or more operations on the neck (p = 0.0004), intratho racic goitres (p = 0.0002), large goitres (p = 0.0002), and those havi ng emergency operations (p = 0.0091). Conclusion: The decline in the n umber of operations for benign goitre at Odense University Hospital pa rallels the increase in waiting time before operation. This can be exp lained by loss of operating room capacity rather than introduction of some alternative cure for goitre or change of criteria for operation. Certain groups of patients are at higher risk of complications than ot hers.