Correlation of modified Thyroidectomy Difficulty Scale with postoperative outcomes following thyroidectomy for multinodular euthyroid goiters in a tertiary hospital, southwest Nigeria

ABSTRACT Background: In Nigeria, many patients present late with large goiter with attendant intraoperative challenges. Complications following thyroidectomy can sometimes be life-threatening or may be associated with significant morbidity. The ability to intraoperatively identify patients who may be at risk of postoperative complications might be of immense clinical value in terms of preparedness. The modified Thyroidectomy Difficulty Scale (mTDS) has been used in a number of studies for this purpose, but has not been evaluated in our setting. This study evaluated the usefulness of the mTDS in predicting the occurrence of postoperative complications among adult patients undergoing thyroidectomy. Materials and Methods: It was a prospective, hospital-based observational study conducted in the General Surgery Units of the Department of Surgery, OAUTHC, Ile-Ife. Thirty-nine patients scheduled for elective thyroidectomy were recruited into the study. Intraoperatively, mTDS, a four-item scale which is scored 1–3 using the following items: vascularity, friability, mobility/fibrosis and gland size, was done by the surgeon. The specimens were weighed on a scale, and the weight was noted in grams. Postoperative complications, including tension hematoma, hypocalcemia, vocal cord palsy, and voice change, were noted and documented. Patients with postoperative complications were managed as appropriate and in line with the unit protocols. Results: Fifteen (38.5%) patients had a difficult thyroidectomy, while 24 (61.5%) patients had a nondifficult thyroidectomy. One (2.6%) patient had a tension hematoma and also had a difficult thyroidectomy, but this was not statistically significant ( P = 0.572). Eight (20.5%) patients had hypocalcemia and also had a difficult thyroidectomy, and this was statistically significant ( P = 0.017). Two (5.1%) patients had unilateral vocal cord palsy; one of these patients had total thyroidectomy, and the other had subtotal thyroidectomy. Twelve (30.8%) patients had a voice change. Conclusion: The novel mTDS could predict complications, such that a higher number of complications were found more in difficult thyroidectomies.