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Objective: Utilize data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) to identify risk factors for morbidity and mortality following thyroidectomy. Design: Retrospective cohort study of thyroidectomy patients with 30 day follow-up. Setting: 503 participating hospitals were queried to identify all patients undergoing thyroid surgery over a 5 year period (2005-2010) based on Current Procedural Terminology (CPT) codes. Patients: 38,577 patients identified from the ACS-NSQIP database. Interventions: Partial, total and substernal thyroidectomy. Main outcome measures: The primary study outcome was to identify non-modifiable pre-operative risk factors associated with morbidity and mortality up to 30 days
following the initial operation. Adverse outcomes included readmission, and return to the operating room. Morbidity included pulmonary, infectious, neurological, renal and cardiovascular complications. Logistic regression analysis was performed using Stata. Results: Overall, 30 day mortality and morbidity were 0.06% and 1.49%, respectively. The most common co-morbidities of hypertension (37.3%), diabetes (10.84%), advanced age >70years (10.56%), and COPD (1.81%) were associated with significantly increased mortality with odds ratios (OR) of 4.7, 4.6, 4.0, and 4.7, respectively (p≤0.035) and morbidity with ORs of 1.4, 1.4, 2.1, and 3.5 (p≤0.006). The co-morbidity associated with the highest risk was end stage renal failure requiring dialysis (0.38%). Multiple co-morbidities resulted in significantly escalating cumulative risk. The presence of 3 co-morbidities resulted in postoperative morbidity of 5.1% (OR 5.4; 95% CI 4.0-7.4; p<0.001) and mortality as high as 12.5%. Conclusions:
Thyroid surgery is generally safe. However, common co-morbidities do significantly increase the risk of adverse outcomes, including death. Clinically applicable risk calculation based on overall health may improve patient selection, surgical management, and patient informed consent.