Predictors of Complications After Elective Thyroid Surgery: A Retrospective Cohort Study

Introduction: Elective thyroid surgery continues to be a standard treatment for benign and malignant thyroid diseases when conservative therapy is insufficient. Despite advances in surgical techniques, postoperative complications remain a concern. Aim: This study aimed to analyse postoperative complication rates in patients who underwent elective thyroidectomy, focusing on identifying predisposing and protective factors. Materials and methods: A total of 507 patients underwent elective thyroidectomy after endocrinological evaluation and, when indicated, fine-needle aspiration cytology (FNAC). Intraoperative recurrent laryngeal nerve monitoring was performed, and the resected thyroid specimens were evaluated for volume and histopathology. The postoperative outcomes included surgical complications, parathyroid dysfunction, and calcium level abnormalities. Results: The study cohort consisted of 404 women (79.7%) and 103 men (20.3%), with a mean age of 53.6 13.9 years. The mean thyroid volume was 167.9 170.7 ml, and it was larger in men than in women (209.5 192.2 vs. 157.3 163.4 ml; p = 0.0063). Overall, 400 complications were observed, with hypocalcaemia being the most common one (representing 62.3% of complications) and affecting 249 patients (49.1% of the cohort). Female sex was associated with a 2.7-fold higher risk of postoperative parathyroid dysfunction and a 3-fold higher risk of calcium level abnormalities compared with male patients. No independent predictors of complications were identified, and no mortality occurred. Conclusions: Elective thyroidectomy is safe, with no procedure-related mortality, and hypocalcaemia and parathyroid dysfunction remain the leading complications. Larger prospective studies and meta-analyses should be performed to further evaluate thyroid volume as an independent risk factor and to establish the definitions of calcium abnormalities.