Incidence of complications in thyroid surgery – a 10-year retrospective analysis of 2,537 surgeries

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Introduction: Surgical treatment of thyroid disease is associated with a certain degree of morbidity and mortality; the most serious complications include recurrent laryngeal nerve (RLN) palsy, persistent hypocalcemia, postoperative bleeding, surgical site infection, and deterioration of the patient’s overall health. The aim of this study was to determine the incidence of complications (morbidity and mortality) associated with thyroid surgery. Methods: A retrospective analysis was conducted of thyroid surgeries performed between 2013 and 2022. Patient demographic and clinical data, as well as postoperative complications – including death within 7 days of surgery, hypocalcemia, RLN paresis, and surgical wound healing complications – were evaluated. Statistical analysis focused on assessing the sensitivity and specificity of intraoperative neuromonitoring (IONM) in relation to the occurrence of postoperative complications. Results: A total of 2,537 thyroid surgeries were included in the retrospective analysis. Intraoperative neuromonitoring was used for 2,614 at-risk nerves; 1,329 at-risk nerves were evaluated without the use of IONM. The incidence of unilateral permanent RLN paresis was 0.31%. No cases of permanent bilateral vocal cord paralysis were recorded. Transient hypocalcemia was observed in 13.1% of patients, and permanent hypocalcemia developed in only 2.85% of patients. Postoperative bleeding occurred in 1.14% of patients. No surgery-related deaths were recorded in the study cohort. Conclusion: The use of IONM contributes to achieving a low incidence of permanent unilateral RLN palsy. The overall incidence of this complication was very low in the cohort (0.31% of exposed nerves). The incidence of hypocalcemia corresponds to the data reported in the scientific literature. Various surgical approaches were associated with low morbidity and zero mortality, even in patients with malignant thyroid tumors.