No Additional Morbidity Associated with Adding Neck Dissection to a Thyroidectomy: a NSQIP Analysis of 44,887 Patients

Background: The potential oncologic benefit of adding neck dissection to thyroidectomy procedures is balanced with a presumed increased morbidity from more extensive surgery. Although there has been some literature documenting the risks of adverse events (AE) from neck dissection in single institutions, there has not been a large volume analysis to investigate this issue. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) 2005–2012 registry was queried to identify all patients undergoing thyroidectomy, with or without associated neck dissection. Patients were propensity-score matched 1:1 for preoperative factors. Outcomes of interest included surgical wound and medical complications, reoperation, and mortality. Univariate and multivariate analyses were utilized to identify predictors of these events. Odds ratios were calculated for adverse events between cohorts. Results: A total of 44,887 patients were identified for analysis. Of these, 38,449 (85.4%) underwent an Isolated Thyroidectomy (IT) procedure without neck dissection, and 6,438 (14.6%) underwent a Thyroidectomy with Neck Dissection (TND). After matching, there were 4,814 patients found to have similar pre-operative comorbidities, demographics and operative factors. There was a higher rate of overall complications in the IT group (4.25%) than the TND group (3.00%, p<0.001). There was no statistically significant difference in surgical complications. There was, however, a statistically significant increase in medical complications in the IT group (3.83%) over the TND group (2.68%, p=0.005). There was no difference in post-operative mortality between both groups. There was a higher rate of return to the operating room for the IT group (2.54%) compared to the TND group (1.54%, p=0.004). Conclusions: The morbidity and mortality of thyroid surgery is relatively low overall. In this analysis there was no measurable increase in the complications conferred by the addition of a neck dissection. These data are important for patient informed consent, risk stratification, and surgical planning.