Introduction: Recent studies have shown worse postoperative outcomes following several surgeries in underweight or obese patients. However, the association between body mass index (BMI) and short-term outcomes following thyroid cancer surgery remains unclear because of the small number of patients, deficits in background data known as risk factors (e.g., cancer stage, operative procedure, intraoperative device use and hospital volume) and categorisation of BMI.
Methods: We identified patients who underwent thyroidectomy for differentiated thyroid cancer from July 2010 to March 2017 using a Japanese nationwide inpatient database. We used restricted cubic spline (RCS) analyses to investigate potential nonlinear associations between BMI (without categorisation) and outcomes: postoperative complications (local and general), duration of anaesthesia, postoperative length of hospital stay and hospitalisation costs. The analyses were adjusted for demographic and clinical backgrounds including above-stated factors. We also performed multivariable regression analyses for the outcomes with categorisation of BMI.
Results: Among 59,671 eligible patients, the median BMI was 22.9 kg/m2 (interquartile range [IQR], 20.7–25.6 kg/m2). In total, 3860 patients (6.5%) had local complications and 787 patients (1.3%) had general complications. Although there were no significant associations with local complications, such as bleeding, recurrent laryngeal nerve paralysis and surgical site infection, the occurrence of general complications was significantly associated with higher BMI. BMI showed a linear association with duration of anaesthesia and U-shaped associations with postoperative length of stay and hospitalisation costs. The lowest points of the U-shaped curves occurred at a BMI of approximately 24 kg/m2. The multivariate regression analyses showed consistent results with the RCS analyses.
Discussion/conclusion: Whereas RCS analyses revealed no significant associations between BMI and postoperative local complications, obese was significantly associated with the occurrence of general complications. The linear association between BMI and duration of anaesthesia corresponds with previous studies. Although postoperative length of stay and total hospitalisation costs demonstrated U-shaped associations, the slight differences would not be clinically important. Even if surgeons must pay attention to general complications in obese patients undergoing thyroid cancer surgery as well as other surgeries, underweight and overweight patients can undergo thyroidectomy as safely as patients with normal B