Association of Case Management Nursing with Swallowing and Voice Recovery and Quality of Life After Transoral Thyroidectomy: A Retrospective Study with Predictive Modeling

Aim: To investigate the association of case management nursing (CMN) with swallowing and voice function recovery and quality of life (QOL) improvement after transoral thyroidectomy, and to develop a predictive model for favorable comprehensive postoperative recovery. Methods: This retrospective study included 256 patients undergoing transoral thyroidectomy (CMN group, n = 128; control group, n = 128). The 10-item Eating Assessment Tool (EAT-10), 10-item Voice Handicap Index (VHI-10), and 36-item Short Form Health Survey (SF-36) scores were compared. Linear mixed-effects models were constructed to analyze time effects and group × time interactions on functional recovery. Logistic regression was used to identify factors associated with favorable comprehensive recovery at 3 months. Model discrimination and calibration were evaluated. Internal validation was performed using 1000 bootstrap resamples. Results: EAT-10 and VHI-10 scores peaked at 24 hours post-surgery in both groups, then gradually declined. Linear mixed-effects models showed significant time effects (all P < 0.05) and significant CMN × time interactions. At 3 months, the CMN group had significantly higher SF-36 scores ( P < 0.001) and greater ΔSF-36 ( P < 0.001) versus controls. Multivariable logistic regression identified CMN as an independent factor associated with favorable recovery ( OR = 14.816, 95% CI : 6.563– 36.813, P < 0.001). The prediction model showed an apparent AUC of 0.794 (95% CI: 0.737– 0.850), which decreased to an optimism-corrected AUC of 0.776 after 1000 bootstrap resamples. The optimism-corrected Brier score, calibration intercept, and calibration slope were 0.164, − 0.003, and 0.921, respectively. Conclusion: CMN was associated with better swallowing and voice recovery and improved QOL after transoral thyroidectomy. The prediction model showed acceptable internal performance but requires external validation before clinical application. Keywords: case management nursing, transoral thyroidectomy, swallowing function, voice function, quality of life, predictive model, linear mixed-effects model