Long-Term Scar Perception and Quality of Life After Open Thyroidectomy in Chinese Patients: A Cross-Sectional Survey Study

<b><i>Background:</i></b> Patient-reported scar perception and quality of life (QoL) are critical, yet understudied, outcomes in open thyroid surgery. While the postoperative time is likely to shape patients' recovery trajectories, its relationship with scar perception and QoL remains unknown. <b><i>Methods:</i></b> In this cross-sectional study, adult patients with thyroid cancer who underwent open thyroidectomy at Peking Union Medical College Hospital and two affiliated institutions between 2013 and 2024 were stratified by postoperative interval (POI) (≤1, 1-2, 2-3, 3-5, >5 years). Data were collected from electronic medical records. Scar perception (assessed using the Patient Scar Assessment Questionnaire [PSAQ]) and QoL (evaluated using the 39-item Thyroid-Related Patient-Reported Outcome [ThyPRO-39]) were assessed via a blinded web-based questionnaire. Associations between POI and these outcomes were evaluated using linear regression. Mediation analysis was conducted to quantify the effects of POI on QoL via scar perception. <b><i>Results:</i></b> Of 1962 eligible patients, 1387 responded (response rate 70.7%), and 1334 patients were included in the final analysis. Scar perception improved progressively with longer POI (β for >5 years vs. ≤1 year, -14.75 [95% confidence intervals [CI], -17.69 to -11.82]), with the most rapid improvement in the total PSAQ scores observed within the first two postoperative years (β for 1-2 years vs. ≤1 year, -6.24 [95% CI, -8.65 to -3.84]). QoL gains followed similar temporal patterns (β for >5 years vs. ≤1 year, -4.79 [95% CI, -6.50 to -3.04], <i>p</i> < 0.001). Secondary analyses showed that obesity and lateral lymph node dissection were significantly associated with the total PSAQ score only in females, but not in males. Mediation analysis indicated that the effect of POI on QoL was fully mediated by scar perception. <b><i>Conclusions:</i></b> Post-thyroidectomy scar perception improves dynamically over time and serves as a primary driver of QoL enhancements. This process exhibits sex-specific patterns, highlighting the first two postoperative years as a critical period for scar-related interventions to enhance long-term patient outcomes.