Factors Associated with Post-Thyroidectomy Upper Airway Obstruction: a Retrospective Study at Udonthani Cancer Hospital

Abstract

Post-thyroidectomy upper airway obstruction is a serious complication that can be life-threatening. This study aimed to analyze the factors associated with the occurrence of upper airway obstruction following thyroidectomy. A retrospective analytical study was conducted on 223 patients who underwent thyroid surgery at Udonthani Cancer Hospital between January 2020 and December 2023. Data collected included sex, age, diagnosis, type of surgery, duration of thyroid enlargement, vocal cord mobility, tracheal position, and tumor extension into the mediastinum. Intraoperative data included difficulty of intubation, recurrent laryngeal nerve injury, intraoperative blood loss greater than 100 milliliters, and thyroid gland weight exceeding 200 grams. Postoperative data used to evaluate upper airway obstruction included failed extubation and tracheostomy within 48 hours after surgery. The results showed that 64 patients (28.7%) experienced failed extubation, the majority of whom were diagnosed with thyroid cancer (55.16%). Factors significantly associated with postoperative upper airway obstruction included a diagnosis of thyroid cancer (adjusted OR=4.56, 95%CI: 1.95– 10.68, p<0.001), preoperative vocal cord immobility (adjusted OR=10.08, 95%CI: 1.60–63.42, p=0.009), preoperative tracheal narrowing or deviation (adjusted OR=3.05, 95%CI: 1.05–8.84, p=0.042), thyroid gland weight greater than 200 grams (adjusted OR=7.28, 95%CI: 1.80–29.33, p=0.004), and intraoperative blood loss greater than 100 milliliters (adjusted OR=9.45, 95%CI: 4.20– 21.23, p<0.001). Therefore, patients with these risk factors require meticulous planning for postoperative extubation and close postoperative airway monitoring. Preoperative counseling should also include discussion about the potential need for prolonged intubation or tracheostomy to ensure patient safety following thyroid surgery.