Gynecology Xagena

Pregnancy: thyroid and parathyroid surgery outcomes may be worse

Pregnant women appear to have worse clinical and economic outcomes after thyroid and parathyroid surgery compared with women who are not pregnant.

Thyroid and parathyroid surgery are used to treat cancer and other conditions. The incidence of thyroid cancer has increased by almost 250 percent over the last 30 years, increasing from 3.6 to 8.7 cases per 100,000 persons.
The rate is almost double in pregnant women, with 14.4 cases per 100,000 persons. Hyperthyroidism has been reported in 0.1 percent to 0.4 percent of pregnancies. Inadequately treated hyperthyroidism during pregnancy poses significant risks to both mother and fetus. Outcomes after thyroid and parathyroid procedures during pregnancy have not been well characterized in the surgical literature.

SreyRam Kuy, of Yale University School of Medicine, New Haven, and United States Department of Veterans Affairs, Washington, and colleagues compared clinical and economic outcomes of thyroid and parathyroid surgery performed on 201 pregnant women ( average age 29 ) and a group of 31,155 age-matched, non-pregnant women from 1999 to 2005. Fetal, maternal and surgical complications as well as in-hospital death, length of stay and hospital costs were measured.

Of the 201 pregnant women, 165 underwent thyroid procedures and 36 underwent parathyroid procedures. Compared with non-pregnant women, pregnant patients had a higher rate of endocrine ( 15.9% vs 8.1% ) and general complications ( 11.4% vs 3.6% ), longer unadjusted lengths of stay ( two days vs one day ) and higher unadjusted hospital costs ( $6,873 vs. $5,963 ). The fetal and maternal complication rates were 5.5% and 4.5%, respectively. Additionally, pregnant patients had higher surgical complications than non-pregnant patients for benign ( 27% vs 14% ) and malignant ( 21% vs 8% ) thyroid diseases while undergoing thyroidectomy.

Differences between pregnant and non-pregnant women in complication rates were most pronounced by diagnosis, race and hospital size. When compared to non-pregnant women of the same race, white pregnant patients had double the complication rate ( 21% vs 10% ), black pregnant patients had nearly five times the complication rate ( 48% vs 10% ) and Hispanic pregnant patients had an almost three-fold higher complication rate ( 30% vs 12% ).

These data suggest that thyroid and parathyroid surgery during pregnancy should be approached with caution and careful deliberation about whether the risks are outweighed by the benefits. Surgeon volume is an important predictor of outcomes, so pregnant women undergoing thyroid and parathyroid procedures should be directed to high-volume surgeons whenever possible. ( Xagena )

Source: Archives of Surgery, 2009