Predictors of postoperative complications following thyroidectomy: A systematic review

Introduction: Thyroidectomy is considered a relatively safe procedure with a low risk of postoperative complications, making it challenging to identify predictors of complications to improve shared decision making. Recent advancements in clinical bioinformatics and surgical decision-making tools have the potential to improve patient outcomes. This systematic review aimed to assess the current understanding of factors predicting such complications following thyroidectomy. Methods: We searched PubMed/MEDLINE, Web of Science, and EMBASE for studies published between 2010 and October 2023, investigating predictors of postoperative complications after thyroidectomy. Studies were included if they investigated predictors of hypocalcemia, hypoparathyroidism, vocal cord paresis (VCP), hematoma, or other postoperative complications. Studies solely reliant on univariate and ROC analyses were excluded. Independent predictors of each postoperative complication were evaluated and categorized as biochemical, surgical, and patient/disease specific. Results: Forty-five studies were included. Biochemical hypocalcemia and transient hypoparathyroidism were the most investigated complications, with reported rates ranging from 15.7 % to 76.7 % and 12.9 % to 53.8 %, respectively. The majority of studies (n = 35, 77 %) focused on these complications. Biochemical markers (e.g., serum calcium, parathyroid hormone) were the most frequent predictors identified for these complications. Surgical factors (inadvertent parathyroidectomy) were frequently studied for all complications. Age, gender, and thyroid pathology were common patient/disease-specific predictors. Conclusion: This review highlights the disparity in research on complication predictors. Most studies focused on hypocalcemia and hypoparathyroidism, with fewer examining VCP, hematoma, and mortality. Notably, a lack of high-quality evidence exists due to the scarcity of prospective and randomized controlled trials. Future research should explore incorporating a wider range of independent predictors, especially surgical factors, into comprehensive predictive models. This review can serve as a foundation for developing such models to improve risk prediction for a broader spectrum of thyroidectomy complications.