Modified versus conventional intubation and early versus delayed oral intake in thyroid surgery: a 2 × 2 factorial randomized controlled trial.

BACKGROUND

Enhanced recovery after thyroid surgery remains variably implemented. The optimal approach to endotracheal intubation and timing of postoperative oral intake is still debated.

OBJECTIVE

To evaluate the safety and feasibility of a modified electromyographic (EMG) endotracheal intubation protocol and early oral intake (EOI) after thyroid surgery, and their impact on recovery, procedural efficiency, and patient comfort.

DESIGN

Single-centre, prospective, 2 × 2 factorial randomised controlled trial.

SETTING

Peking Union Medical College Hospital, Beijing, China (April 2023 - February 2024).

PARTICIPANTS

Two hundred adult patients scheduled for elective thyroid surgery with intraoperative neural monitoring.

INTERVENTIONS: Patients were randomized to receive either modified or conventional EMG intubation protocols, and subsequently to either early oral intake (within 1 h post-extubation) or delayed intake (6 h postoperatively).

MAIN OUTCOME MEASURES: The primary outcome was the Quality of Recovery-15 (QoR-15) score on postoperative day one. Secondary outcomes included QoR-15 on postoperative day two, intubation time, endotracheal tube readjustment, sore throat, thirst, hunger, nausea, vomiting, incisional pain, patient satisfaction, gastrointestinal recovery time, drainage volume, length of hospital stay, and adverse events.

RESULTS

QoR-15 scores on postoperative day one did not differ significantly between groups. However, the modified intubation protocol reduced intubation time (median difference: - 13.0 s) and sore throat severity. EOI alleviated thirst and hunger without increasing adverse events. No group differences were observed in length of hospital stay or patient satisfaction.

CONCLUSION

While overall recovery scores remained unchanged, both the modified EMG intubation protocol and early oral intake improved perioperative comfort and procedural efficiency. These strategies are safe, feasible, and may be incorporated into enhanced recovery pathways for thyroid surgery.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05624463.