Outcomes in Pediatric Thyroid Surgery Across Multiple Institutions.

INTRODUCTION

Surgical management plays a crucial role in managing thyroid disease in the pediatric population as evidenced by the increasing volume of such cases over the years. This study aims to evaluate the outcomes of thyroid surgery in children, adolescents, and young adults by meta-analyzing outcomes across several institutions.

METHODS

A comprehensive literature search for single institutional studies was performed across PubMed, Science Direct, Embase, Scopus, and Google Scholar. Key variables like mean hospital stay and both transient and permanent complications were recorded. Transient hypocalcemia or hypoparathyroidism was defined as a drop in serum calcium below laboratory reference range postthyroidectomy that resolved within 6 mo. Transient laryngeal nerve injury was characterized by hoarseness or dysphonia arising from neuropraxia or trauma to the nerve that resolved within 6 mos postsurgery. Complications persisting beyond 6 mo were classified as permanent. We performed meta-analysis on complication rates using the metaprop library on R studio.

RESULTS

A total of 2339 studies were retrieved through our search strategy across five databases. Excluding duplicates, the remaining studies were screened resulting in 88 studies being selected for a full text review. Fifty-six studies were excluded due to a lack of outcome specific data leaving a total of thirty-two studies that were included, amounting to 2747 patients with a mean of 86 patients per study. The overall weighted mean age of patients in our study pool was 12.9 ± 4.1 (95% confidence interval [CI]: 12.8-13.1) years. Mean hospital stay was 2.6 ± 1.9 (95% CI: 2.5-2.7) days. Common complications like transient hypocalcemia or hypoparathyroidism was found in 24% (95% CI: 0.2-0.3, I2 = 91%) and transient laryngeal nerve injury was 2% (95% CI: 0.01-0.02, I2 = 35%) of patients. Permanent hypocalcemia or hypoparathyroidism was found in 3% (95% CI: 0.02-0.04, I2 = 65%) patients. Rare complications included permanent laryngeal nerve injury in 1% (95% CI: 0.00-0.01) and hematoma formation in 1% (95% CI: 0.00-0.01).

CONCLUSIONS

Pediatric thyroid surgery, although safe, has a high risk of transient hypocalcemia or hypoparathyroidism. Other complications remain under 3%.