Impact Of BMI On Complications And Satisfaction In Patients With Papillary Thyroid Cancer And Lateral Neck Metastasis

Background and Objective:Thyroid cancer is the most common surgical endocrine malignancy.The incidence of obesity is increasing at an alarming rate around the world,and there are now more patients with high BMI who have undergone head and neck surgery than ever before.Surgeons not only need to successfully bypass more fat and soft tissue during surgery,but also must be prepared to deal with many medical complications associated with obesity.This study investigated the effects of body mass index(BMI)on complications and satisfaction in patients who have undergone thyroidectomy and lateral neck resection.Methods:We analyzed the clinical data of 296 patients who underwent thyroid surgeries in the head and neck thyroid surgery department at the Affiliated Tumor Hospital of Zhengzhou University from September 01,2016 to October 30,2018.According to the"Guidelines for Prevention and Control of Overweight and Obesity in Adults in China",the subjects were divided into three groups according to BMI:Group A,B,and C.Group A was normal(18.5 kg/m~2?BMI<24 kg/m~2),group B was overweight(24 kg/m~2?BMI<28 kg/m~2);group C was obese(BMI?28 kg/m~2).Results:Two hundred and ninety-six patients were enrolled in the study,including 128 males(43.24%)and 168 females(56.76%).According to the group,the number of patients in group A,group B,and group C was 153 patients,69 patients,and 74 patients,respectively.There was a statistically significant difference in the operation time between groups A,B,and C(P<0.001).However,there was no statistically significant difference in intraoperative blood loss(P=0.130)and drainage between the three groups(P=0.719).Totally there were 82 patients(27.70%)developed hypocalcemia.There were 80 patients who had transient hypocalcemia,41 patients,20 patients and 19 patients in group A,B and C respectively.There was no significant difference in the incidence of transient hypocalcemia between the three groups(P=0.902).Two patients had permanent hypocalcemia and the small number of cases,we did not perform statistical analysis.What't more,a total of 28 patients had postoperative hoarseness,of which 25(8.4%)returned to normal within one year after surgery 14(9.1%)in group A,6(3.9%)in group B,and 5(6.7%)in group C.There was a hoarseness after surgery,and there was no significant difference in the transient injury of recurrent laryngeal nerve between the three groups(P=0.828).Three patients in group A did not return to normal in one year after operation,B group and group C did not have permanent recurrent laryngeal nerve injury,no statistical analysis was performed.The chyle leakage was the rarest complication(1.01%),and there was no significant difference among the three groups.Postoperative hematoma occurred in 11 patients(3.72%).There were 4 patients,1 patient,and 6 patients in group A,B,and C,respectively,We combined group A and group B with group C.The chi-square group test significantly increased the risk of infection in obese patients.POH was positively correlated with BMI(P=0.021).Similarly,the probability of postoperative infection in the three groups was relatively low(2.36%).There were 1patients,2 patients,and 4 patients in group A,group B,and group C.Due to the small number of cases,we did not perform statistical analysis.Sixty-seven patients had"shoulder syndrome"after operation.Twenty patients(13.72%),19 patients(27.54%),and 28 patients(35.44%)in group A,B,and C,respectively.The risk of“shoulder syndrome”was high,and there was a significant difference between the three groups(P<0.001).Interestingly,the four characteristic scores and total scores of the VSS scores among the three groups were statistically significantly different(P<0.001).Similarly,as the BMI increasing,the patient's Likert score increased,and the subjective satisfaction was higher,and there was a significant difference between the three groups(P<0.001).Conclusion:1.P atients with high BMI have longer operation time,and the risk of complications such as postoperative bleeding and“shoulder syndrome”is higher.BMI was not associated with recurrent laryngeal nerve injury,hypocalcemia.2.Patients with high BMI had higher subjective satisfaction and VSS scores for surgical incisions.3.The relationship between the incidence of postoperative infection,chyluria and BMI is not clear and further research is needed.