Voice outcomes after total thyroidectomy, partial thyroidectomy, or non-neck surgery using a prospective multifactorial assessment

Diego A. Vicente, Nancy P. Solomon, Itzhak Avital, Leonard R. Henry, Robin S. Howard, Leah B. Helou, George L. Coppit, Craig D. Shriver, Chester C. Buckenmaier, Steven K. Libutti, Ashok R. Shaha, Alexander Stojadinovic

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21 Citations (Scopus)

Abstract

Background Voice alteration remains a significant complication of thyroid surgery. We present a comparison of voice outcomes between total thyroidectomy (TT), partial thyroidectomy (PT), and non-neck (NN) surgery using a multifactorial voice-outcomes classification tool. Study Design Patients with normal voice (n = 112) were enrolled between July 2004 and March 2009. The patients underwent TT (n = 54), PT (n = 35), or NN (n = 23) surgery under general endotracheal anesthesia as part of a prospective observational study involving serial multimodality voice evaluation preoperatively, and at 2 weeks, 3 months, and 6 months postoperatively. Patients with adverse voice outcomes were grouped into the negative voice outcomes (NegVO) category, including patients with objective (abnormality on videolaryngostroboscopy and substantial voice dysfunction) and subjective (normal videolaryngostroboscopy but with notable voice impairment) NegVO. Voice outcomes were compared among study groups. Results Negative voice outcomes occurred in 46% (95% CI, 34-59%) and 14% (95% CI, 6-30%) of TT and PT groups, respectively. No NegVOs were observed after NN surgery. Early NegVOs were more common in the TT group than in the NN or PT groups (p < 0.001). Most voice disturbances resolved by 6 months (TT 84%; PT 92%) with no difference in NegVO among all groups (p = 0.23). Black race and significant changes in certain voice outcomes measures at the 2-week follow-up visit were identified as predictors of late (3 to 6 months) NegVO. Conclusions This comprehensive voice outcomes study revealed that the extent of thyroidectomy impacts voice outcomes in the early postoperative period, and identified risk factors for late NegVO in post-thyroidectomy patients who should be considered for early voice rehabilitation referral.

Original languageEnglish (US)
Pages (from-to)152-163
Number of pages12
JournalJournal of the American College of Surgeons
Volume219
Issue number1
DOIs
StatePublished - 2014

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Thyroidectomy
Endotracheal Anesthesia
Outcome Assessment (Health Care)
Voice Disorders

ASJC Scopus subject areas

  • Surgery

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Voice outcomes after total thyroidectomy, partial thyroidectomy, or non-neck surgery using a prospective multifactorial assessment. / Vicente, Diego A.; Solomon, Nancy P.; Avital, Itzhak; Henry, Leonard R.; Howard, Robin S.; Helou, Leah B.; Coppit, George L.; Shriver, Craig D.; Buckenmaier, Chester C.; Libutti, Steven K.; Shaha, Ashok R.; Stojadinovic, Alexander.

In: Journal of the American College of Surgeons, Vol. 219, No. 1, 2014, p. 152-163.

Research output: Contribution to journalArticle

Vicente, DA, Solomon, NP, Avital, I, Henry, LR, Howard, RS, Helou, LB, Coppit, GL, Shriver, CD, Buckenmaier, CC, Libutti, SK, Shaha, AR & Stojadinovic, A 2014, 'Voice outcomes after total thyroidectomy, partial thyroidectomy, or non-neck surgery using a prospective multifactorial assessment', Journal of the American College of Surgeons, vol. 219, no. 1, pp. 152-163. https://doi.org/10.1016/j.jamcollsurg.2014.03.019
Vicente, Diego A. ; Solomon, Nancy P. ; Avital, Itzhak ; Henry, Leonard R. ; Howard, Robin S. ; Helou, Leah B. ; Coppit, George L. ; Shriver, Craig D. ; Buckenmaier, Chester C. ; Libutti, Steven K. ; Shaha, Ashok R. ; Stojadinovic, Alexander. / Voice outcomes after total thyroidectomy, partial thyroidectomy, or non-neck surgery using a prospective multifactorial assessment. In: Journal of the American College of Surgeons. 2014 ; Vol. 219, No. 1. pp. 152-163.
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abstract = "Background Voice alteration remains a significant complication of thyroid surgery. We present a comparison of voice outcomes between total thyroidectomy (TT), partial thyroidectomy (PT), and non-neck (NN) surgery using a multifactorial voice-outcomes classification tool. Study Design Patients with normal voice (n = 112) were enrolled between July 2004 and March 2009. The patients underwent TT (n = 54), PT (n = 35), or NN (n = 23) surgery under general endotracheal anesthesia as part of a prospective observational study involving serial multimodality voice evaluation preoperatively, and at 2 weeks, 3 months, and 6 months postoperatively. Patients with adverse voice outcomes were grouped into the negative voice outcomes (NegVO) category, including patients with objective (abnormality on videolaryngostroboscopy and substantial voice dysfunction) and subjective (normal videolaryngostroboscopy but with notable voice impairment) NegVO. Voice outcomes were compared among study groups. Results Negative voice outcomes occurred in 46{\%} (95{\%} CI, 34-59{\%}) and 14{\%} (95{\%} CI, 6-30{\%}) of TT and PT groups, respectively. No NegVOs were observed after NN surgery. Early NegVOs were more common in the TT group than in the NN or PT groups (p < 0.001). Most voice disturbances resolved by 6 months (TT 84{\%}; PT 92{\%}) with no difference in NegVO among all groups (p = 0.23). Black race and significant changes in certain voice outcomes measures at the 2-week follow-up visit were identified as predictors of late (3 to 6 months) NegVO. Conclusions This comprehensive voice outcomes study revealed that the extent of thyroidectomy impacts voice outcomes in the early postoperative period, and identified risk factors for late NegVO in post-thyroidectomy patients who should be considered for early voice rehabilitation referral.",
author = "Vicente, {Diego A.} and Solomon, {Nancy P.} and Itzhak Avital and Henry, {Leonard R.} and Howard, {Robin S.} and Helou, {Leah B.} and Coppit, {George L.} and Shriver, {Craig D.} and Buckenmaier, {Chester C.} and Libutti, {Steven K.} and Shaha, {Ashok R.} and Alexander Stojadinovic",
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T1 - Voice outcomes after total thyroidectomy, partial thyroidectomy, or non-neck surgery using a prospective multifactorial assessment

AU - Vicente, Diego A.

AU - Solomon, Nancy P.

AU - Avital, Itzhak

AU - Henry, Leonard R.

AU - Howard, Robin S.

AU - Helou, Leah B.

AU - Coppit, George L.

AU - Shriver, Craig D.

AU - Buckenmaier, Chester C.

AU - Libutti, Steven K.

AU - Shaha, Ashok R.

AU - Stojadinovic, Alexander

PY - 2014

Y1 - 2014

N2 - Background Voice alteration remains a significant complication of thyroid surgery. We present a comparison of voice outcomes between total thyroidectomy (TT), partial thyroidectomy (PT), and non-neck (NN) surgery using a multifactorial voice-outcomes classification tool. Study Design Patients with normal voice (n = 112) were enrolled between July 2004 and March 2009. The patients underwent TT (n = 54), PT (n = 35), or NN (n = 23) surgery under general endotracheal anesthesia as part of a prospective observational study involving serial multimodality voice evaluation preoperatively, and at 2 weeks, 3 months, and 6 months postoperatively. Patients with adverse voice outcomes were grouped into the negative voice outcomes (NegVO) category, including patients with objective (abnormality on videolaryngostroboscopy and substantial voice dysfunction) and subjective (normal videolaryngostroboscopy but with notable voice impairment) NegVO. Voice outcomes were compared among study groups. Results Negative voice outcomes occurred in 46% (95% CI, 34-59%) and 14% (95% CI, 6-30%) of TT and PT groups, respectively. No NegVOs were observed after NN surgery. Early NegVOs were more common in the TT group than in the NN or PT groups (p < 0.001). Most voice disturbances resolved by 6 months (TT 84%; PT 92%) with no difference in NegVO among all groups (p = 0.23). Black race and significant changes in certain voice outcomes measures at the 2-week follow-up visit were identified as predictors of late (3 to 6 months) NegVO. Conclusions This comprehensive voice outcomes study revealed that the extent of thyroidectomy impacts voice outcomes in the early postoperative period, and identified risk factors for late NegVO in post-thyroidectomy patients who should be considered for early voice rehabilitation referral.

AB - Background Voice alteration remains a significant complication of thyroid surgery. We present a comparison of voice outcomes between total thyroidectomy (TT), partial thyroidectomy (PT), and non-neck (NN) surgery using a multifactorial voice-outcomes classification tool. Study Design Patients with normal voice (n = 112) were enrolled between July 2004 and March 2009. The patients underwent TT (n = 54), PT (n = 35), or NN (n = 23) surgery under general endotracheal anesthesia as part of a prospective observational study involving serial multimodality voice evaluation preoperatively, and at 2 weeks, 3 months, and 6 months postoperatively. Patients with adverse voice outcomes were grouped into the negative voice outcomes (NegVO) category, including patients with objective (abnormality on videolaryngostroboscopy and substantial voice dysfunction) and subjective (normal videolaryngostroboscopy but with notable voice impairment) NegVO. Voice outcomes were compared among study groups. Results Negative voice outcomes occurred in 46% (95% CI, 34-59%) and 14% (95% CI, 6-30%) of TT and PT groups, respectively. No NegVOs were observed after NN surgery. Early NegVOs were more common in the TT group than in the NN or PT groups (p < 0.001). Most voice disturbances resolved by 6 months (TT 84%; PT 92%) with no difference in NegVO among all groups (p = 0.23). Black race and significant changes in certain voice outcomes measures at the 2-week follow-up visit were identified as predictors of late (3 to 6 months) NegVO. Conclusions This comprehensive voice outcomes study revealed that the extent of thyroidectomy impacts voice outcomes in the early postoperative period, and identified risk factors for late NegVO in post-thyroidectomy patients who should be considered for early voice rehabilitation referral.

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