Complications and Risk Factors of Thyroid Gland Surgery at the Yaounde University Teaching Hospital from 2013 to 2015

RESUME Introduction. La thyroidectomie est regulierement pratiquee en Chirurgie generale et ORL. Les patients operes pour thyroidectomie arrivent tardivement en consultation et sont porteurs de volumineuses masses. Cela implique-t-il plus de complications post-operatoires? Quels sont les facteurs de risque associes a ces complications ? Methodologie. Nous avons realise une etude cas-temoins (Juin 2013-Juillet 2015) en ORL au CHU de Yaounde. Tous les patients operes d’une thyroidectomie et qui avaient donne leur consentement eclaire etaient inclus dans l’etude. Les donnees socio-demographiques, cliniques et chirurgicales ont ete collectees et analysees. Les patients ayant presente une complication (Cas) etaient compares aux autres (Temoins) pour les facteurs de risque. Le rapport de cotes et l’intervalle de confiance a 95% ont ete calcules. Resultats. Nous avons colliges 90 cas de thyroidectomies. 17 patients (18,9%) ont developpe des complications post-operatoires. 7 (7,8%) hematomes dont 2 etaient compressifs et ont necessite une reprise chirurgicale ; 8 cas (8,8%) de paralysie recurrentielle dont 3 ont ete tracheotomises et un seul a garde une paralysie bilaterale permanente. 2 patients ont presente des crises de tetanie, traites avec succes par du calcium. Les facteurs de risque apres analyse etaient la presence d’un prolongement intra-thoracique et le score TIRADS >= 4. Conclusion. L’incidence des complications transitoires apres thyroidectomie est de 18,9% dans notre service ; elle chute a 2,2% pour les complications permanentes. Les facteurs de risque retrouves sont le goitre avec prolongement thoracique et un score TIRADS >= 4. Ces elements devraient etre pris en compte avant toute chirurgie thyroidienne. ABSTRACT Aim. Thyroidectomy is a common surgical procedure performed in general surgery and Otorhinolaryngology (ORL). In our setting, most patients operated for thyroidectomy present very late with large tumours. Does that imply more post-operative complications? Which risk factors are associated with them? Methods. We carried out a case control study (June 2013 - July 2015), at the ORL department of the Yaounde University Teaching Hospital (CHUY). All patients, operated for thyroidectomy by our team and who gave their consent were included. Socio-demographic, clinical and surgical data were collected and analysed. Patients who presented complications (cases) were compared to the others (controls) for risk factors. The Odds ratio and the 95% confidence intervals were calculated. Results. 90 thyroidectomies were recruited. 17 (18.9%) developed transient post-operative complications. 7 had cervical hematoma (7.8%) with 2 compressive ones who were re-operated.  8 had recurrent laryngeal nerve (RLN) palsy (8.8%), 3 were operated for tracheostomy, the tube was furthermore removed but 2 (2.2%) had permanent RLN palsy. 2 Patients suffered from tetanic crisis and were treated with intravenous then oral calcium. Independent risk factors after the logistic regression were the presence of an endo-thoracic component of the goitre and the TI-RADS grade equals or greater than 4 at the ultrasonography. Conclusion. The incidence of post thyroidectomy transient complications is 18.9% in our department but dropped to 2.2% for permanent complications. The risk factors are intra- thoracic goitres and TI-RADS grade equals or greater than 4. These factors have to be addressed in order to reduce complications.