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- Title
Autofluorescence-Guided Total Thyroidectomy in Low-Volume, Nonparathyroid Institutions.
- Authors
Abood, Ali; Rolighed, Lars; Triponez, Frédéric; Vestergaard, Peter; Bach, Jacob; Ovesen, Therese
- Abstract
Key Points: Question: Is the use of autofluorescence in thyroid surgery associated with lower hypoparathyroidism rates following total thyroidectomy in low-volume thyroid institutions without experience in parathyroid surgery? Findings: In this cohort study of 78 patients who underwent autofluorescence-guided total thyroidectomy and were compared with a historical cohort of 89 patients undergoing conventional total thyroidectomy, the rates of both immediate and permanent hypoparathyroidism decreased significantly after the introduction of autofluorescence. Meaning: These results suggest that low-volume institutions with no experience in parathyroid surgery may have lower rates of postoperative hypoparathyroidism when using autofluorescence in thyroid surgery. This cohort study investigates the rates of hypoparathyroidism following total thyroidectomy after the introduction of autofluorescence-guided surgery in low-volume, nonparathyroid institutions in Denmark. Importance: Hypoparathyroidism following thyroid surgery is a serious complication that occurs frequently when surgery is performed by low-volume thyroid surgeons without experience in parathyroid surgery. Objective: To evaluate the occurrence of hypoparathyroidism following total thyroidectomy after the introduction of autofluorescence in low-volume, nonparathyroid institutions. Design, Setting, and Participants: This prospective, multicenter cohort study, with a follow-up period of up to 1 year, was conducted in Denmark at 2 low-volume nonparathyroid institutions between January 2021 and November 2023. All adult patients referred for total thyroidectomy were assessed for eligibility (n = 90). Only patients with no history of thyroid surgery were considered (n = 89). Patients who only underwent lobectomy (n = 6) or declined to participate (n = 5) were excluded. All included patients completed follow-up. The prospective cohort was compared with a historical cohort of successive patients undergoing primary total thyroidectomy from 2016 to 2020 (before autofluorescence was available). Intervention: Included patients underwent autofluorescence-guided total thyroidectomy. Main outcomes and Measures: Rate of hypoparathyroidism. Immediate hypoparathyroidism was defined as the need for active vitamin D postoperatively, whereas permanent hypoparathyroidism was considered when there still was a need for active vitamin D 1 year after surgery. Results: Seventy-eight patients underwent autofluorescence-guided surgery (mean [SD] age, 55.6 [13.1] years; 67 [86%] female) and were compared with 89 patients in the historical cohort (mean [SD] age, 49.7 [12.8] years; 78 [88%] female). The rate of immediate hypoparathyroidism decreased from 37% (95% CI, 27%-48%) to 19% (95% CI, 11%-30%) after the introduction of autofluorescence (P =.02). Permanent hypoparathyroidism rates decreased from 32% (95% CI, 22%-42%) to 6% (95% CI, 2%-14%) (P <.001), reaching 0% at the end of the study. More parathyroid glands were identified with autofluorescence (75% [95% CI, 70%-80%] vs 61% [95% CI, 56%-66%]) (P <.001) and less parathyroid glands were inadvertently excised (4% [95% CI, 1%-11%] vs 21% [95% CI, 13%-31%]) (P =.001). Conclusions and Relevance: In this cohort study of autofluorescence-guided thyroid surgery in low-volume, nonparathyroid institutions, the use of autofluorescence was associated with a significant decrease in both immediate and permanent hypoparathyroidism. When autofluorescence was used, hypoparathyroidism rates were comparable with those of high-volume surgeons who also perform parathyroid surgery.
- Subjects
DENMARK; PREVENTION of surgical complications; THERAPEUTIC use of vitamin D; HYPOPARATHYROIDISM; STATISTICAL correlation; POSTOPERATIVE care; DIAGNOSTIC imaging; RESEARCH funding; T-test (Statistics); CREATININE; FISHER exact test; HOSPITALS; TREATMENT effectiveness; DESCRIPTIVE statistics; MANN Whitney U Test; CHI-squared test; SURGICAL complications; PARATHYROID hormone; CALCIUM; LARYNGOSCOPY; PRE-tests &; post-tests; RESEARCH methodology; RESEARCH; COMPARATIVE studies; CONFIDENCE intervals; DATA analysis software; THYROTROPIN; THYROIDECTOMY; REGRESSION analysis; VITAMIN D
- Publication
JAMA Network Open, 2024, Vol 7, Issue 5, pe2411384
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.11384