Routine use of intraoperative nerve monitoring is associated with a reduced risk of vocal cord dysfunction after thyroid cancer surgery.
Routine use of intraoperative nerve monitoring is associated with a reduced risk of vocal cord dysfunction after thyroid cancer surgery.
复制标题
DOI：
10.1186/s12893-023-02122-3
复制
发表时间：
2023-08-02
期刊：
影响因子：
1.9
通讯作者：
Roman, Sanziana
中科院分区：
文献类型：
--
作者：
Wilhelm, Alexander;Conroy, Patricia C. C.;Calthorpe, Lucia;Frye, Willow;Sosa, Julie Ann;Roman, Sanziana
本研究的目的是调查个体外科医生的术中神经监测（IONM）实践与甲状腺癌患者接受甲状腺切除术后声带（VC）功能障碍相关因素之间的相关性。使用协作内分泌手术质量改进计划（CESQIP）2014-21数据，多变量logistic回归分析研究了与短期和长期VC功能障碍相关的变量、常规使用IONM与术后结局的相关性以及与IONM使用相关的患者特征。在5，446例患者（76.7%为女性，平均年龄49岁）中，68.5%的患者由外科医生使用IONM进行手术，其中≥ 90%的病例（63%的外科医生，n = 73）。术后VC功能障碍的诊断喉镜在3.0%的患者在短期和2.7%的长期。当外科医生常规使用IONM时，VC功能障碍的发生率短期为2.4%，长期为2.2%，而当外科医生不常规使用IONM时，VC功能障碍的发生率分别为4.4%和3.7%（p < 0.01）。调整后，常规使用IONM与短-（OR 0.48，p < 0.01）和长期（OR 0.52，p < 0.01）VC功能障碍，短期内术后甲状旁腺功能减退的风险较低，（OR 0.67，p < 0.01）和长期（OR 0.54，p < 0.01），并且当天出院的可能性更高（OR 2.03，p < 0.01）。甲状腺外肿瘤扩展和N1分期是术后VC功能障碍的短期（OR 3.12，p < 0.01; OR 1.92，p = 0.01）和长期（OR 3.11，p <0.01; OR 2.32，p < 0.01）相关因素。常规使用IONM与内分泌手术特异性并发症的风险降低和当天出院的可能性增加独立相关。
The aim of this study was to investigate the associations between individual surgeon’s intraoperative nerve monitoring (IONM) practice and factors associated with vocal cord (VC) dysfunction in patients with thyroid cancer undergoing thyroidectomy. Using Collaborative Endocrine Surgery Quality Improvement Program (CESQIP) 2014-21 data, multivariable logistic regression analyses investigated variables associated with short- and long-term VC-dysfunction, associations of routine use of IONM with postoperative outcomes, and patient characteristics associated with IONM use. Among 5,446 patients (76.7% female, mean age 49 years), 68.5% had surgery by surgeons using IONM in ≥ 90% of cases (63% of surgeons, n = 73). Post-operative VC-dysfunction was diagnosed by laryngoscopy in 3.0% of patients in the short-term and 2.7% in the long-term. When surgeons routinely used IONM, the incidence of VC-dysfunction was 2.4% in the short-term and 2.2% in the long-term, compared to 4.4% and 3.7%, respectively, when surgeons did not routinely use IONM (p < 0.01). After adjustment, routine use of IONM was independently associated with reduced risk of short- (OR 0.48, p < 0.01) and long-term (OR 0.52, p < 0.01) VC-dysfunction, a lower risk of postoperative hypoparathyroidism in the short- (OR 0.67, p < 0.01) and long-term (OR 0.54, p < 0.01), and higher likelihood of same-day discharge (OR 2.03, p < 0.01). Extrathyroidal tumor extension and N1-stage were factors associated with postoperative VC-dysfunction in the short- (OR 3.12, p < 0.01; OR 1.92, p = 0.01, respectively) and long-term (OR 3.11, p < 0.01; OR 2.32, p < 0.01, respectively). Routine use of IONM was independently associated with a lower risk of endocrine surgery-specific complications and greater likelihood of same-day discharge.
登录
查看更多内容
影响因子：
9.6
作者：
Abdelhamid, A.;Aspinall, S.
通讯作者：
Aspinall, S.
影响因子：
9.6
作者：
Al-Qurayshi, Z.;Kandil, E.;Randolph, G. W.
通讯作者：
Randolph, G. W.
影响因子：
7.8
作者：
Rocke, Daniel J.;Goldstein, David P.;de Almeida, John R.
通讯作者：
de Almeida, John R.
影响因子：
9
作者：
Adam, Mohamed Abdelgadir;Thomas, Samantha;Sosa, Julie A.
通讯作者：
Sosa, Julie A.
影响因子：
2.6
作者：
Alesina, P. F.;Hinrichs, J.;Walz, M. K.
通讯作者：
Walz, M. K.