DOI: 10.5061/dryad.k3j9kd55q
title: Comparison of different thyroid surgical procedures and their outcomes/complications for benign disease in relation to expertise of the surgeon in a public hospital of a developing country over 2 decades

description: Objective: To compare the frequency of postoperative complications with
 thyroid surgical procedures and the expertise of the surgeon. Design:
 Retrospective cross-sectional study from 1999 to 2018. Setting: A public
 sector tertiary care teaching hospital. Participants and methods: Patients
 undergoing thyroid surgery (lobectomy with isthmusectomy, subtotal
 thyroidectomy (STT), near total thyroidectomy (NTT), or total
 thyroidectomy (TT)) were included. Expertise level 1, 2 and 3 (L1, L2, L3)
 of the surgeon was based on years of experience or number of thyroid
 surgeries to their credit. Primary and Secondary Outcome Measures:
 Postoperative complications (hypocalcemia, recurrent laryngeal nerve (RLN)
 damage, airway obstruction, hemorrhage and mortality) were measured
 against type of thyroid surgery and expertise of surgeon. Results: 833
 thyroid surgeries were performed on 695 (83.43%) females and 138 (16.57%)
 males. 502 (60.26%) STT, 228 (27.37%) TT, 61 (7.32%) NTT, 42 (5.04%)
 lobectomies with isthmusectomies were performed, with LI, 2, and 3
 surgeons performing 21.25%, 45.74% and 33.01%, respectively. L1, 2 and 3
 surgeons caused 49.47%, 33.45% and 17.08% of adverse events respectively.
 The permanent hypocalcemia, RLN damage and mortality were significantly
 (p&lt;0.05) more common in surgeries performed by L1 compared with L2
 and L3.  Transient and permanent hypocalcemia, transient and
 permanent RLN damage and mortality were significantly (p&lt;0.01) more
 common for total thyroidectomy compared to subtotal thyroidectomy.
 Conclusion: Minimizing the occurrence of complications like permanent
 hypocalcemia, RLN damage and mortality, expertise of the surgeon and
 anticipated difficulty of the procedure needs to be taken into account
 while selecting a thyroid procedure. Keywords: Thyroid surgery, Total
 thyroidectomy, Subtotal thyroidectomy, near total thyroidectomy, Lobectomy
 with isthmusectomy, hypoparathyroidism, hypocalcemia, recurrent laryngeal
 nerve, postoperative complications
description: This data set describes the complications for benign thyroid
 surgery over twenty years in a tertiary care center in Pakistan. This is
 stratified according to the level of expertise of operating surgeon, type
 of surgery, type of complication and year. Moreover, surgical workload
 (outpatient and inpatient) is also added within the data file.
 This is
 a retrospective study done over a period of 20 years, from 1999 to 2018.
 The study setting is of a public sector tertiary care teaching hospital
 affiliated with Rawalpindi Medical University. Inclusion criteria
 comprised of all patients with goiter irrespective of age and sex who
 underwent any thyroid surgery (lobectomy with isthmusectomy, subtotal
 thyroidectomy (STT), near total thyroidectomy (NTT), or total
 thyroidectomy (TT)). All preoperative, operative and post-operative
 findings were recorded in detail for every patient. The detail of
 surgical option for each patient was retrieved from the operative notes. 
 The level of expertise of the operating surgeon was divided in to three
 categories on either the number of total thyroid surgeries performed or
 years of surgical experience in a tertiary care teaching
 hospital. Level 1 was a
 surgeon with more than 5 years of experience and  50 thyroid surgeries to
 his credit, level 2, a surgeon with 10 years of experience and  100
 thyroid surgeries, and level 3 a senior surgeon with 15 plus years of
 experience and  150 thyroid surgeries. All patients
 were observed post operatively for variable period of time in ward. The
 patients were followed in the outpatient at weekly interval for 2 weeks,
 monthly for 6 months and then yearly or as necessary according to the
 nature of the disease. Medical
 records were retrieved from the monthly audit data. They were reviewed for
 variables like age, sex, preoperative diagnosis, extent of surgery,
 postoperative calcium levels, transient and permanent hypocalcemia,
 hoarseness, reason and need for tracheostomy, hemorrhage/ hematoma, any
 need to re explore, wound infection, histopathological records and
 mortality. The post-thyroidectomy hypocalcemia on 1st, 2nd and
 5<sup>th</sup> postoperative day and at six months following
 surgery was measured. Transient hypocalcemia was defined as serum calcium
 less than 8.0 mg/dl (2mmol/L) on at least two consecutive measurements or
 signs and symptoms of hypocalcemia (perioral numbness, digital
 paresthesia, or positive Chvostek or Trousseau’s sign). Permanent
 hypocalcemia was defined as the need for calcium and or vitamin D
 supplements to maintain normal calcium levels at six months or more after
 the date of surgery
description: Type of Surgery There were four basic
 modalities to surgically treat benign diseases of goitre. Subtotal
 thyroidectomy (STT), Total Thyroidectomy (TT), Lobectomy(Lob) and Near
 total thyroidectomy (NTT) are referenced in the excel file.
 Complications The type of surgery and level of
 expertise of the operating surgeon were related to the type of
 complication. Permanent Hypocalcemia (Hypoc Perm) is
 defined as the need for calcium and or vitamin D supplements to maintain
 normal calcium levels at six months or more after the date of
 surgery Transient Hypocalcemia (Hypoc Trans) is defied
 as serum calcium less than 8.0 mg/dl (2mmol/L) on at least two consecutive
 measurements or signs and symptoms of hypocalcemia (perioral numbness,
 digital paresthesia, or positive Chvostek or Trousseau’s sign).
 Tracheostomy, Hypothyroidism, hyper thyroididsm and hemorrhage
 are also mentioned as complications in the excel file.
 Level of expertise of the surgeon Level of
 expertise of the surgeon are judged as follows; Level 1
 was a surgeon with more than 5 years of experience and  50 thyroid
 surgeries to his credit, level 2, a surgeon with 10 years of experience
 and  100 thyroid surgeries, and level 3 a senior surgeon with 15 plus
 years of experience and  150 thyroid surgeries.
 Legend Sheet 1, Sheet2 and Sheet 7 (
 Complications during thyroid surgeries broken down on the basis of level
 of expertise and type of surgery) Hypocalc Trans = 
 Transient Hypocalcemia Hypocalc Perm = Permanent
 Hypocacemia RLN Trans = Transient Recurrent Laryngeal
 Nerve paralysis RLN Perm = Permanent Recurrent
 Laryngeal Nerve paralysis Tracheostomy
 Hemorrhage W inf = Wound Infection
 Hypothy = Hypothyroidism Hyperthy =
 Hyperthyroidism Complis = Complications
 SST= Subtotal Thyroidectomy NTT= Near total
 Thyroidectomy TT= Total thyroidectomy
 Lobec = Lobectomy L1 = Level 1 specialist
 surgeon L2 = Level 2 specialist surgeon
 L3 = Level 3 specialist Surgeon  
 Sheet 3 ( Number of complications per year)
 Complis = Complications SST= Subtotal
 Thyroidectomy NTT= Near total Thyroidectomy
 TT= Total thyroidectomy Lobec =
 Lobectomy L1 = Level 1 specialist surgeon
 L2 = Level 2 specialist surgeon L3 = Level 3
 specialist Surgeon   Sheet 4 ( Total
 outpatient, inpatient and surgical workload) OPD= Out
 patient department visits Admiss = Admissions
 Elect = Elective surgeries  
 Sheet 5 (Presentation of patients with thyroid disease)
 Euthy = Euthyroid  Hyperthy =
 Hyperthyroid Hypothy = Hypothyroid
 MNG = Multinodular goitre SolitNod = Solitary
 Nodule Diffuse = Diffuse goitre
   Sheet 6 ( thryoid surgeries for benign
 disease performed per year  ) SST= Subtotal
 Thyroidectomy NTT= Near total Thyroidectomy
 TT= Total thyroidectomy Lobec =
 Lobectomy