Nerve monitoring decreases recurrent laryngeal nerve injury risk for neoplasm-related thyroidectomy

William Duong; Areg Grigorian; Cyrus Farzaneh; Dawn Elfenbein; Maki Yamamoto; Kathryn Rosenbaum; Michael Lekawa; Jeffry Nahmias

doi:10.1016/j.amjsurg.2021.10.013

Nerve monitoring decreases recurrent laryngeal nerve injury risk for neoplasm-related thyroidectomy

Am J Surg. 2022 May;223(5):918-922. doi: 10.1016/j.amjsurg.2021.10.013. Epub 2021 Oct 14.

Authors

William Duong¹, Areg Grigorian², Cyrus Farzaneh³, Dawn Elfenbein⁴, Maki Yamamoto³, Kathryn Rosenbaum³, Michael Lekawa³, Jeffry Nahmias³

Affiliations

¹ University of California, Irvine, Department of Surgery, Orange, CA, USA. Electronic address: duongw@hs.uci.edu.
² University of Southern California, Department of Surgery, Los Angeles, CA, USA.
³ University of California, Irvine, Department of Surgery, Orange, CA, USA.
⁴ University of Wisconsin, Madison, Department of Surgery, Madison, WI, USA.

PMID: 34715986
DOI: 10.1016/j.amjsurg.2021.10.013

Abstract

Objective: Conflicting reports exist regarding the benefit of intraoperative neuromonitoring (INM) for patients undergoing thyroidectomy. We hypothesized that in a national sample, the risk of mild and severe RLNi is decreased for patients undergoing neoplasm-related disease (NRD) thyroidectomy with INM compared to patients without INM.

Methods: The database was queried for patients that underwent total thyroidectomy for NRD with and without INM. A multivariable logistic regression model was used to determine the associated odds of RLNi.

Results: From 6942 patients, 4269 (61.5%) had INM during thyroidectomy. Patients with INM had a similar rate of overall RLNi compared to patients without INM (5.7% vs. 6.6%, p = 0.118). After adjusting for covariates, INM was associated with decreased odds of severe-RLNi (OR 0.23, p = 0.036) but not mild-RLNi (p = 0.16).

Conclusion: INM is associated with a nearly 80% decreased associated odds of severe RLNi during thyroidectomy for NRD. Future prospective confirmation is needed, and if confirmed, patients undergoing thyroidectomy for NRD should have INM to reduce the risk of RLNi and its associated morbidity.

Keywords: Intraoperative neuromonitoring; Recurrent laryngeal nerve injury; Thyroid neoplasm; Thyroidectomy; Thyroidectomy for neoplasm-related disease.

MeSH terms

Humans
Neoplasms*
Recurrent Laryngeal Nerve
Recurrent Laryngeal Nerve Injuries* / etiology
Recurrent Laryngeal Nerve Injuries* / prevention & control
Retrospective Studies
Thyroidectomy / adverse effects