Recurrent Nerve Injury After Total Thyroidectomy: Risk Factor Analysis of a Targeted NSQIP Data Set.

Background: Recurrent laryngeal nerve (RLN) injury is a significant complication after thyroidectomy. Understanding risk factors for RLN injury and the associated postoperative complications may help inform quality improvement initiatives.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) thyroidectomy-targeted database was utilized for patients undergoing total thyroidectomy between 2016 and 2017. Univariable and multivariable regression were used to identify factors associated with RLN injury.

Results: A total of 6538 patients were identified. The overall rate of RLN injury was 7.1% (467/6538). Of these, 4129 (63.1%) patients had intraoperative neuromonitoring (IONM), with an associated RLN injury rate of 6.5% (versus 8.2% without). African American and Asian race, non-elective surgery, parathyroid auto-transplantation, and lack of RLN monitoring were all significantly associated with nerve injury on multivariable analysis (P<.05). Patients with RLN injury were more likely to experience cardiopulmonary complications, re-intubation, longer length of stay, readmission, and reoperation. Patients who had IONM and sustained RLN injury remained at risk for developing significant postoperative complications, although the extent of cardiopulmonary complications was less severe in this cohort.

Discussion: Recurrent laryngeal nerve injury is common after thyroidectomy and is associated with significant morbidity, despite best practices. Attention to preoperative characteristics may help clinicians to further risk stratify patients prior to thyroidectomy. While IONM does not mitigate all complications, use of this technology may decrease severity of postoperative complications.