Early postoperative complications of Thyoidectomy at the Moi teaching and referral hospital, Eldoret, Kenya .

Abstract

BACKGROUND: Complications arising from thyroidectomy can be life threatening and the morbidity, lifelong. The complication rate, a sensitive measure of the quality of surgery, varies from center to center. This study aims to quantify and characterize these complications at MTRH. OBJECTIVE: To investigate the spectrum and distribution of early postoperative complications of thyroidectomy and their determinant factors. METHODOLOGY: Study design: observational, cross sectional. Sampling technique: Consecutive purposive. Sample size: 74 patients. Study Site: MTRH general surgery outpatient clinics, inpatient wards and operating theatres. Study period: August 2012 - July 2013. Eligibility: goitre patients with an indication for thyroidectomy. Exclusion: prior neck irradiation, neck dissection. Study variables: Patient demographics, goitre characteristics, surgery indications, extent of surgery and intraoperative observations were analyzed as determinant factors. Study tool: Interviewer administered questionnaire. Analysis: Contingency tables with Fischer’s exact and Student’s t-tests used to evaluate association between complications and multiple determinant factors. Statistical significance set at p-value <0.05. RESULTS: There were 73 females and 1 male recruited into the study with mean±SD age of 49.54±12.584 years. Overall complication rate was 33.8% (n = 25). This corresponded to 9 (12.2%) hypoparathyroidism, 4 (5.4%) laryngeal nerve palsies, 2 (2.7%) hematomas, 5 (6.8%) flap oedema, 3 (4.1%) surgical site infections, 6 (8.1%) seromas and 3 (4.1%) airway obstructions. Significant determinant factors were extent of resection (p=<0.001), FNAC malignancy (p=0.026), FNAC thyroiditis (p=0.007). Older age was associated with higher risk of wound infection (p=0.001). Most goitres were WHO grades II and III, benign and non-toxic. CONCLUSIONS: Early post-thyroidectomy complications are common. Hypoparathyroidism is the most frequent. Extent of resection is the main determinant factor. RECOMMENDATIONS: Surgeons should have a high threshold for performing extensive resections. Consider adopting established global perioperative protocols for thyroid surgery that include routine parathyroid gland auto-transplantation in extensive resections. iv