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

<p><b><u>Objective</u></b>: To compare the frequency of postoperative complications with thyroid surgical procedures and the expertise of the surgeon.</p> <p><b><u>Design</u></b>: Retrospective cross-sectional study from 1999 to 2018.</p> <p><b><u>Setting:</u></b> A public sector tertiary care teaching hospital.</p> <p><b><u>Participants and methods</u></b>: 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.</p> <p><b><u>Primary and Secondary Outcome Measures:</u></b> Postoperative complications (hypocalcemia, recurrent laryngeal nerve (RLN) damage, airway obstruction, hemorrhage and mortality) were measured against type of thyroid surgery and expertise of surgeon.</p> <p><b><u>Results:</u></b> 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.</p> <p><b><u>Conclusion:</u></b> 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.</p> <p><b><u>Keywords:</u></b> Thyroid surgery, Total thyroidectomy, Subtotal thyroidectomy, near total thyroidectomy, Lobectomy with isthmusectomy, hypoparathyroidism, hypocalcemia, recurrent laryngeal nerve, postoperative complications</p>