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

• Published in: The American journal of surgery 2022-05, Vol.223 (5), p.918-922
• Main Authors: Duong, William, Grigorian, Areg, Farzaneh, Cyrus, Elfenbein, Dawn, Yamamoto, Maki, Rosenbaum, Kathryn, Lekawa, Michael, Nahmias, Jeffry
• Format: Article
• Language: English
• Subjects: Airway management; Chronic obstructive pulmonary disease; Dyspnea; Gender; Health risks; Hospitals; Humans; Hypocalcemia; Intraoperative neuromonitoring; Intubation; Morbidity; Mortality; Neoplasms; Nerves; Ostomy; Otolaryngology; Patients; Pneumonia; Recurrent Laryngeal Nerve; Recurrent Laryngeal Nerve Injuries - etiology; Recurrent Laryngeal Nerve Injuries - prevention & control; Recurrent laryngeal nerve injury; Regression models; Retrospective Studies; Risk; Thyroid cancer; Thyroid neoplasm; Thyroidectomy; Thyroidectomy - adverse effects; Thyroidectomy for neoplasm-related disease; Tumors
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2021.10.013

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. 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. 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). 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. •Retrospective review of prospectively collected ACS-NSQIP Thyroidectomy database.•Of 6942 patients undergoing thyroidectomy, 4269 used intraoperative neuromonitoring.•Similar rate of overall nerve injury in intraoperative nerve monitor use and without.•Nerve monitoring was associated with decreased odds of severe nerve injury.