Patterns and Outcomes of Surgical Management of Thyroid Disease in Kenyatta National Hospital

Abstract

Background: Thyroid conditions are a common occurrence in local hospitals with a postulated upward trend. Patterns of surgical management and outcomes of thyroid disease vary from region to region and even Centre to Centre. Different extents of surgical intervention are undertaken for various thyroid conditions. No study has been conducted on the outcomes associated with different types of thyroidectomies in all surgical units at KNH. Objectives: To determine the pattern of surgical management and associated outcomes of thyroid disease at Kenyatta National Hospital. Methodology: This was a retrospective cross-sectional study conducted at Kenyatta National Hospital between January 2018 to December 2022.Consecutive sampling was used where 208 thyroid disease patients who were 13 years and above and had undergone surgical management were recruited into the study. Data was cleaned and entered into SPSS version 26.0 for data analysis. Continuous data was summarized using mean and standard deviation while frequencies and percentages were used to summarize categorical data. The Chi-square test or Fisher’s exact test were utilized for differences in proportions and Student T-test used for differences in means. Statistical significance was set at <0.05. Results: The average age was 45.7(SD±13.85) with 84.1% of them being female patients. The common indication for surgery among thyroid disease patients included cosmesis (41.1%), compressive symptoms (27.5%) and malignancy or suspicious for malignancy (17.4%). Among thyroid disease patients who underwent surgical procedure, 44.4% had Multinodular Goiter (MNG), 29.5% had diffuse goitre, 13.5% had malignancy while 11.1% had thyroid nodule. Pattern of surgical management showed that 35.1% underwent near total, 24.5% underwent total thyroidectomy,22.1% underwent lobectomy,13.0% hemi-thyroidectomy and 5.3% subtotal. There was significant association between thyroid pathology and management approach (p =0.012). The mean length of hospital stay was 3.8 (±3.4) days with a median of 3 days (Interquartile Range [IQR]: 1 – 6) days. Patients who underwent total or near total procedure had a significantly higher length of hospital stay with a mean of 4.3(SD±3.9) days compared to those who underwent sub-total or lobectomy with mean of 3.2(SD±1.7) days, t = 2.359, p =0.019. Complications identified included symptoms of RNLI (9.7%), hematoma (3.4%) and hypocalcaemia (2.4%). Conclusion and recommendations: The high burden of specific thyroid conditions coupled with late large goitre presentations suggest that many patients in our set up could benefit from surgical intervention. More extensive surgical approach can be adopted tailored to specific thyroid condition without a significant increase in complication rate. Addressing the identified complications through standardized postoperative care and complication management protocols will further enhance patient recovery and satisfaction