Intraoperative neuromonitoring during thyroidectomy does not decrease vocal cord palsy risk, but the cumulative experience of the surgeon may

• Published in: Surgery today (Tokyo, Japan) Vol. 54; no. 11; pp. 1401 - 1409
• Main Authors: Bae, Hye Lim, Oh, Moon Young, Han, Mira, Wu, Che-Wei, Chai, Young Jun
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.11.2024
• Subjects: Adult; Aged; Clinical Competence; Female; Humans; Intraoperative Complications - epidemiology; Intraoperative Complications - etiology; Intraoperative Complications - prevention & control; Intraoperative Neurophysiological Monitoring - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Monitoring, Intraoperative - methods; Original; Original Article; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Retrospective Studies; Risk; Risk Factors; Surgery; Surgical Oncology; Thyroid Neoplasms - surgery; Thyroidectomy - adverse effects; Vocal Cord Paralysis - epidemiology; Vocal Cord Paralysis - etiology; Vocal Cord Paralysis - prevention & control; Thyroid cancer; Intraoperative neuromonitoring; Vocal cord palsy; Thyroidectomy; Risk factors
• ISSN: 0941-1291; 1436-2813; 1436-2813
• DOI: 10.1007/s00595-024-02871-5

Purpose To evaluate the influence of intraoperative neuromonitoring (IONM) on vocal cord palsy (VCP) rates and assess the temporal trends in VCP rates. Methods The subjects of this retrospective study were patients who underwent thyroidectomy for thyroid cancer between March, 2014 and June, 2022, at a university hospital in Korea. We compared VCP rates between the non-IONM and IONM groups and analyzed the risk factors for VCP and VCP rates over time. Results A total of 712 patients were included in the analysis. The rates of transient and permanent VCP did not differ significantly between the non-IONM and IONM groups. Transient VCP occurred in 4.6% and 4.3% patients ( p  = 0.878) and VCP was permanent in 0.7% and 0.4% patients ( p  = 0.607) in the non-IONM and IONM groups, respectively. Among the nerves at risk, transient damage occurred in 2.8% and 3.0% patients ( p  = 0.901), and permanent damage occurred in 0.4% and 0.3% ( p  = 0.688), respectively. Multivariate analysis revealed no significant risk factors for VCP. There was a significant decreasing trend in VCP rates over time as the cumulative number of cases increased ( p  = 0.017). Conclusions IONM did not reduce the risk of VCP significantly. However, the declining trend of VCP rates suggests that the surgeon’s experience may mitigate VCP risk.