Factors predictive of the development of surgical site infection in thyroidectomy - An analysis of NSQIP database

Background: Surgical Site Infection (SSI) is an uncommon but serious complication of thyroidectomy when encountered.

Study design: NSQIP Participant Use File (PUF) from 2012 to 2015 were queried. Thyroidectomy was identified with CPT 60210, 12, 20, 25, 40, 52, 54, 60 in patients ≥18 years and clean (Wound Classification 1) wounds. Uni- and multivariate logistic regression testing were performed. A subgroup analysis for patients that underwent thyroidectomy for cancer was performed.

Results: 57,371 patients were included in the study. SSI incidence was 0.4%. On univariate analysis age 18-29, age>70, male gender, BMI 19 to <25, BMI 40 to <50, ASA classes other than class 4, diabetes, White race, COPD, current smoker, CHF, hypertension disseminated cancer and ventilator dependent within 48 h prior to surgery were pre-operative variables with P-value <0.2 between the two groups. On multivariate regression analysis age ≥80, gender male, BMI 40 to <50, current smoker and ventilation within 48 h preceding surgery remained statistically significant. After ventilation, age≥80 was associated with the greatest odds (OR) ratio (2.382). In the subgroup analysis age ≥80, White race, and CHF were predictive of SSI.

Conclusion: SSI following thyroidectomy with a clean wound is rare. Routine use of antibiotics should not be undertaken in patients undergoing thyroidectomy and should only be considered for high risk patients or for those patients with contaminated wounds.