A Study of the incidence of early complications after general anesthesia in thyroid surgery patients at Damascus Hospital

doi:10.21203/rs.3.rs-3898471/v1

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Research Article

A Study of the incidence of early complications after general anesthesia in thyroid surgery patients at Damascus Hospital

https://doi.org/10.21203/rs.3.rs-3898471/v1

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Introduction:

Anesthesia is one of the vital and very important procedures in surgeries, as it helps to relieve pain and reduce stress on the body during surgery, which helps to improve surgical results and reduce the risk of infection. Postoperative throat pain is common, especially after general anesthesia, as endotracheal intubation is associated with a risk of postoperative throat pain, which is more common than when using supraglottic airway openers or a face mask. Thyroid surgeries are associated with many potential surgical complications, with recurrent laryngeal nerve paralysis resulting in unilateral hoarseness, aphonia, and stridor.

Research Materials and Methods:

A retrospective cohort study (COHORT) was conducted from April 2023 to November 2023 including patients attending the Department of General Surgery who had undergone thyroid surgery under general anesthesia in Damascus Hospital, Damascus, Syrian Arab Republic. A paper questionnaire was conducted and patients visiting the General Surgery Department in Damascus Hospital were followed up during the period of conducting the research. Accordingly, the questionnaire was filled out and the data was reviewed under the supervision of the research supervisor.

Results

The sample included 110 patients, of which 9 were excluded, leaving us with 101 cases on which research and statistics were conducted. 95% were females and only 5% were males. Participants are classified into three groups, with the age group (40–60) years representing the majority at 49.5% (mean 42.7 years). The data was distributed according to 3 categories according to TSH, T4, and T3 values

into normal, high, and low. It was found that 84.2% of individuals had normal TSH values, 89.1% of individuals had normal T4 values, and 59.4% of individuals had normal T3 values. Regarding the type of surgery performed, Research and statistics showed that 84.2% of patients underwent total thyroidectomy, mostly because of multi-nodular goiter (enlarged thyroid gland), with a rate of 86.1%. we also studied the relationship between complications, endotracheal tube diameter, and the duration of surgery

Conclusion

It is necessary to use small endotracheal tubes as much as possible and shorten the duration of the surgical procedure as much as possible.

Anesthesiology & Pain Medicine

general anesthesia

thyroid

Damascus Hospital

Anesthesia is one of the vital and very important procedures in surgeries, as it helps to relieve pain and reduce stress on the body during surgery, which helps to improve surgical results and reduce the risk of infection. Also, Anesthesia is used to relieve pain during surgeries, by anesthetizing the area to be operated on, and this helps to reduce the pain felt by the patient during the operation and also helps to reduce the health risks associated with taking pain-relieving medications after surgery [1]. Postoperative throat pain is common, especially after general anesthesia, as endotracheal intubation is associated with a risk of postoperative throat pain, which is more common than when using supraglottic airway openers or a face mask [2]. One prospective cohort study, which included 809 patients, showed that the rate of incidence of sore throat is approximately 40% [3].

Thyroid surgeries are associated with many potential surgical complications, with recurrent laryngeal nerve paralysis resulting in unilateral hoarseness, aphonia, and stridor [4]. Many studies have reported a large series of thyroidectomies without deaths. In other reports, the mortality rate did not differ significantly from the mortality rate resulting from anesthesia alone. However, each patient must be evaluated for comorbidities, and it is important to note There are five major complications associated with thyroid surgery: thyroid storm, wound bleeding, wound infection, recurrent laryngeal nerve injury, and hypoparathyroidism [5].

Finally, Preoperative evaluation by the anesthesiologist reduces postoperative delays or cancellations, improves the patient's experience of hospitalization, reduces anxiety associated with surgery, and reduces complications and mortality rates [6]. Therefore, this research aims to Study the incidence of early complications after general anesthesia in thyroid surgery

A paper questionnaire was conducted and patients visiting the General Surgery Department in Damascus Hospital were followed up during the period of conducting the research. Accordingly, the questionnaire was filled out and the data was reviewed under the supervision of the research supervisor.

The final sample size was 110 participants depending on the Raosoft site [7], with a confidence interval of 95%. Every participant has signed the informed consent.

Inclusion criteria:

- The study included all patients admitted with thyroid problems who had thyroid surgery

- The sample included thyroid surgery patients, especially those with general anesthesia

Exclusion criteria:

- All patients presenting with other problems or other anesthesia methods were excluded.

Ethics approval and consent to participate

Ethical approval was obtained from the Ethical Committee of the Syrian Private University, the necessary approval was provided to Damascus Hospital, and permission was obtained from the hospital to review patients’ files.

Statistical Analysis:

We used Excel 2010, and the Statistical Package for the Social Sciences version 26.0 (SPSS Inc., Chicago, IL, United States). P value < 0.05 was considered statistically significant. We relied on frequency, percentages, and graphs for categorical variables, meanwhile, for continuous variables, standard deviation, range, and median were used. For the statistical relationships, we used the Chi-square test (X2-test).

1-Socio-demographic data

Regarding the distribution of the sample according to habits, 68.3% were smokers and 31.7% were non-smokers. While consuming alcohol, a majority of 98% were non-alcoholic and only 2% of the patients often consumed alcohol.

Finally, for the prevalence of medical history among sample members, The largest percentage of patients suffering from ischemic heart disease with a percentage of 17.8%, and 47.5% of the total sample had no history of any disease.

More detailed demographic data is shown in (Table-1)

Table-1: Socio-demographic data

	n	%
SEX
Male	5	5%
Female	96	95%
AGE
Under 40	39	38.60%
40–60	50	49.50%
60 and above	12	11.90%
Smoking
Non – smoker	69	68.30%
Smoker	32	31.70%
Alcohol consumption
Non - alcoholic	99	98.00%
Alcoholic	2	2.00%
Disease history
Diabetes	3	3%
Hypertension	5	4.90%
High lipids	0	0%
Chronic obstructive pulmonary disease (COPD)	18	17.80%
Carcinomas	0	0%
Hypothyroidism	5	4.90%
Hyperthyroidism	8	7.90%
Other	16	15.80%
None	48	47.50%

2-Thyroid laboratories data

As shown in (Table-2) The data was distributed according to 3 categories according to TSH, T4, and T3 values into normal, high, and low. It was found that 84.2% of individuals had normal TSH values, 89.1% of individuals had normal T4 values, and 59.4% of individuals had normal T3 values.

Table-2: Thyroid laboratory test data

Test	n	%
TSH
Normal (0.4–4)	85	84.20%
Low	8	7.90%
High	8	7.90%
T4
Normal (5–13)	90	89.10%
Low	7	6.90%
High	4	4.00%
T3
Normal (60–80)	60	59.40%
Low	32	31.70%
High	9	8.90%

3-Surgical procedures and post-operation data

Regarding the type of surgery performed, Research and statistics showed that 84.2% of patients underwent total thyroidectomy, mostly because of multi-nodular goiter (enlarged thyroid gland), with a rate of 86.1%.

As for the duration of surgery and postoperative complications, we found After distributing patients into 4 categories according to the duration of surgery in minutes 46.5% underwent surgery lasting 90 to 120 minutes. The most common complication was hoarseness, with a rate of 74.2%.

More detailed information about the distribution of the sample according to the Surgical procedure and post-operation details is shown in (Table-3)

Table-3: Surgical procedure data

	n	%
Surgical procedures
Partially thyroidectomy	16	15.80%
Total thyroidectomy	85	84.20%
The reason behind the Surgical procedures
Suspicious FNA for carcinoma	14	13.90%
Multi-nodular goiter	87	86.10%
Duration of surgery (min)
60–75	12	11.90%
75–90	21	20.80%
90–120	47	46.50%
More than 120	21	20.80%
Complications
Hypocalcemia	19	18.80%
recurrent laryngeal nerve injury	0	0%
Seroma	0	0%
Dyspnea	38	37.60%
Bleeding	0	0%
Dysphagia	51	50.50%
Nausea and vomiting	20	19.80%
hypoparathyroidism	0	0%
Hoarseness	75	74.20%
suffocation	28	27.70%

4-Sample distribution according to the diameter of the endotracheal tube

We asked about The diameter of the endotracheal and the results showed that in 39.65% of cases, the diameter of the endotracheal tube was 6.5 mm, as shown in (Table-4)

Table-4: Sample distribution according to the diameter of the endotracheal tube

diameter of the endotracheal tube (mm)	N	%
6	16	15.80%
6.5	40	39.65%
7	39	38.65%
7.5	6	5.90%

5-Statistical relations

The relationship between complications and endotracheal tube diameter

According to research and statistical analysis, the most common complication of hypocalcemia was found to be associated with the use of a 6 mm diameter tube, which accounted for 84.2% of patients. This was followed by Patients for whom it is used a 6.5 mm diameter tube, with a prevalence of 15.8%.

More detailed statistics about the relationship between complications and endotracheal tube diameter are shown in (Table-5)

Table-5: The relationship between complications and endotracheal tube diameter in (mm)

									P-value
endotracheal tube diameter complications	6mm		6.5 mm		7 mm		7.5 mm		0.0001^*
endotracheal tube diameter complications	N	%	N	%	N	%	N	%
Hypocalcemia	16	84.2%	3	15.8%	0	0%	0	0%
Dysphagia	0	0%	2	3.9%	10	19.6%	39	76.5%
Hoarseness	4	5.3%	8	10.7%	15	20%	48	64%
Nausea and vomiting	4	20%	6	30%	5	25%	5	25%
suffocation	0	0%	0	0%	4	14.3%	24	85.7%
Dyspnea	10	26.3%	12	31.6%	8	28.6%	8	28.6%

^*Significant

In the end, we found that the previous relationship was statistically significant (P-value = 0.0001(

The relationship between the duration of surgery and complications

With regards to the issue of Dysphagia, it is noteworthy that the group with the longest operation duration (over 120 minutes) accounted for the largest proportion at 74.5%, followed by those with an operation duration of 90–120 minutes at 15.7%. Meanwhile, the group with an operation duration of 75–90 minutes represented 5.9% of the total, finally those with an operation duration of 60–75 minutes made up 3.9% of the sample.

More detailed statistics about the relationship between the duration of surgery and complications are shown in (Table-5)

Table-6: The relationship between the duration of surgery and complications

									P-value
duration of surgery complications	60–75 min		75–90 min		90–120 min		More than 120 min		0.0001^*
duration of surgery complications	N	%	N	%	N	%	N	%
Dysphagia	2	3.9%	3	5.9%	8	15.7%	38	74.5%
Hoarseness	2	2.7%	5	6.7%	20	26.7%	48	64%
Nausea and vomiting	2	10%	2	10%	6	30%	10	50%
suffocation	0	0%	4	14.3%	10	35.7%	14	50%

^*Significant

In the end, we found that the previous relationship was statistically significant (P-value = 0.0001(

The study was conducted on a sample of 101 patients. Research and statistics were conducted on them, and then we found statistical relationships between the study variables. It was a cohort study on patients attending Damascus Hospital. A paper questionnaire was organized, filled with information, and checked by the research supervisor.

All members of the sample had undergone thyroid surgery under general anesthesia. The aim was to highlight the incidence of early complications, and the results showed that The largest percentage of participants were between 40–60 years old, at 49.5%, which agrees with the BAJWA study [8], with an average of 46 years. As for gender in our study, the largest percentage was female, at 95%, which agrees with the BAJWA study, at 89% for females.

The aim of studying the distribution of the sample according to the Disease history was to show the role of Disease history as a risk factor. The largest percentage of patients suffered from ischemic heart disease, at a rate of 17.8%, and in total, 47.5% of the total sample had no medical history.

We also studied the distribution of sample categories according to thyroid laboratories (TSH – T4 – T3) To evaluate thyroid function.

BAJWA study and ours show that the most common surgical procedure was total thyroidectomy, but the percentage in our study was 84.2% while in the BAJWA study was 64.5%.

Regarding the distribution of the sample according to the presence of surgical complications, which is the most important percentage around which our research focuses, the most important complication was hoarseness, with a rate of 74.2%.

We also found that in our study, the relationships between complications the diameter of the endotracheal tube, and the duration of surgery were statistically significant where was P-value > 0.05.

Finally, regarding complications, we compared the results of our study with two other studies, BAJWA and BACUZZI [9] studies, as shown in (Table-7). Starting with the complications resulting from intubation, we noticed that there was no formation of a seroma in all studies, as well as bleeding. The injury to the recurrent laryngeal nerve occurred in 2% of the total sample in the BAJWA study. Then we moved on to the rest of the complications. Starting with Dysphagia, which nearly half of our sample suffered from, which is consistent with the second two studies, then hoarseness, which constituted the largest complication in our study at a rate of 74.2%, compared to 20% in the BAJWA study, respiratory depression at a rate of 37.6% in our study, followed by suffocation at a rate of 27.7%, and we did not notice any cases of hypoparathyroidism. There was only a decrease in calcium levels by 18.8% and vague symptoms of nausea and vomiting by 19.8%.

Table-7: comparison between our study, BAJWA study, and BACUZZI study regarding complications after Surgical procedures on the thyroid gland.

Complications	Our study	BAJWA study	BACUZZI study
Hypocalcemia	18.80%	-	-
recurrent laryngeal nerve injury	0%	2%	-
Seroma	0%	0%	0%
Dyspnea	37.60%	27%	30%
Bleeding	0%	0%	0%
Dysphagia	50.50%	50%	51%
Nausea and vomiting	19.80%	-	-
hypoparathyroidism	0%	-	0%
Hoarseness	74.20%	20%	-
suffocation	27.70%	-	-

Limitations

The small number of cases visited the hospital and it takes a lot of time to collect samples and deal with patients.

It is necessary to use small endotracheal tubes as much as possible because of the existence of a directly proportional relationship between the size of the endotracheal tube and the occurrence of hoarseness, dyspnea, and dysphagia. In addition to the necessity of shortening the duration of the surgical procedure as much as possible, there is also a direct proportional relationship between the length of the surgical procedure and the occurrence of hoarseness, dyspnea, dysphagia, Nausea, and vomiting.

Competing of Interest

The authors declare that they have no competing interests.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Acknowledgments

Nile

Availability of data and materials

All authors have read and approved the final version of the manuscript. The Corresponding author had full access to all of the data in this study and takes complete responsibility for the integrity of the data and the accuracy of the data analysis

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The authors declare no competing interests.

Download PDF

Version 1

posted

You are reading this latest preprint version

A Study of the incidence of early complications after general anesthesia in thyroid surgery patients at Damascus Hospital

Status:

Version 1

Abstract

Introduction

Research Materials and Methods

Ethics approval and consent to participate

Statistical Analysis:

Results

Discussion

Conclusion

Declarations

Competing of Interest

Funding

Acknowledgments

Availability of data and materials

References

Additional Declarations

Status:

Version 1