Sex-Specific Differences in Outcomes Following Thyroidectomy: A Population-Based Cohort Study

Lara Gut; Selina Bernet; Monika Huembelin; Magdalena Mueller; Ciril Baechli; Daniel Koch; Christian Nebiker; Philipp Schuetz; Beat Mueller; Emanuel Christ; Fahim Ebrahimi; Alexander Kutz

doi:10.1159/000510618

Sex-Specific Differences in Outcomes Following Thyroidectomy: A Population-Based Cohort Study

Eur Thyroid J. 2021 Nov;10(6):476-485. doi: 10.1159/000510618. Epub 2020 Sep 30.

Authors

Affiliations

¹ Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
² Department of Surgery, Cantonal Hospital of Aarau, Aarau, Switzerland.
³ Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland.
⁴ University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland.

Abstract

Introduction: Numbers of thyroidectomies and awareness of postoperative quality measures have both increased. Potential sex-specific variations in clinical outcomes of patients undergoing thyroidectomy are controversial.

Objective: The aim of this study was to investigate sex-specific differences in outcomes following thyroidectomy.

Methods: This is a population-based cohort study of all adult patients undergoing either hemi- or total thyroidectomy in Switzerland from 2011 to 2015. The primary outcome was all-cause 30-day readmission rate. The main secondary outcomes were intensive care unit (ICU) admission, surgical re-intervention, in-hospital mortality, length of hospital stay (LOS), postoperative calcium disorder, vocal cord paresis, and hematoma.

Results: Of 16,776 patients undergoing thyroidectomy, the majority of patients undergoing thyroidectomy were female (79%), with a median age of 52 (IQR 42-64) years. Within 30 days after the surgery, male patients had significantly higher rates of hospital readmission (adjusted risk ratio [RR] 1.38; 95% confidence interval [95% CI] 1.11-1.72, p = 0.008) and higher risks for postoperative ICU admission (RR 1.25; 95% CI, 1.09-1.44, p = 0.003) than female patients. There were no significant differences among sexes in the LOS, rates of surgical re-interventions, or in-hospital mortality. While postoperative calcium disorders due to hypoparathyroidism were less prevalent among male patients (RR 0.63; 95% CI, 0.54-0.72, p < 0.001), a 2-fold higher incidence rate of postoperative hematoma was observed (RR 1.93, 95% CI, 1.51-2.46, p < 0.001).

Conclusions: Male patients undergoing thyroidectomy have higher 30-day hospital readmission and ICU admission rates. Following surgery, male patients revealed higher rates of neck hematoma, while hypocalcemia was more frequent among female patients.

Keywords: Hematoma; Hypocalcemia; Intensive care unit; Outcome; Postsurgical complications; Readmission; Sex; Thyroidectomy; Vocal cord paresis.