Does intraoperative neuromonitoring of recurrent nerves have an impact on the postoperative palsy rate? Results of a prospective multicenter study.

摘要: Background The impact of intraoperative neuromonitoring on recurrent laryngeal nerve palsy remains debated. Our aim was to evaluate the potential protective effect during total thyroidectomy. Methods This a prospective, multicenter French national study. use left at surgeons' choice. Postoperative laryngoscopy performed systematically day 1 2 after operation and 6 months in case postoperative palsy. Univariate multivariate analyses propensity score (sensitivity analysis) were compare rates between patients operated with or without neuromonitoring. Results Among 1,328 included (females 79.9%, median age 51.2 years, body mass index 25.6 kg/m2), 807 (60.8%) underwent abnormal vocal cord mobility diagnosed 131 (9.92%), including 69 (8.6%) 62 (12.1%) nonintraoperative groups, respectively. Intraoperative associated lesser rate univariate analysis (odds ratio = 0.68, 95% confidence interval, 0.47; 0.98, P = .04) but not (oddsratio = 0.74, 1.17, P = .19), when using ratio = 0.76, 0.53; 1.07, P = .11). There no difference definitive (0.8% 1.3% non-intraoperative groups respectively, P = .39). sensitivity, specificity, positive negative predictive values for detecting 29%, 98%, 61%, 94%, Conclusion does decrease rate. Due its high however, is useful predict normal mobility. From CHU de Nantes,a Clinique Chirurgie Digestive et Endocrinienne, Nantes, France; Lille, Universite Lille,b Generale Nancy—Hopital Brabois,c Service Digestive, Hepato-Biliaire, Nancy, Angers,d Angers, Toulouse—Hopital Larrey,e Thoracique, Pole Voies Respiratoires, Toulouse; Saint-Etienne—Hopital Nord,f ORL Cervico-Faciale Plastique, Saint-Etienne, Limoges—Hopital Dupuytren,g Limoges, Besancon—Hopital Jean Minjoz,h Besancon, Centre Hospitalier du Mans,i Cervico-Faciale, Le Mans, Lyon-Sud,j Generale, Pierre Benite, AP-HM—Hopital La Conception,k Marseille, Rennes—Hopital Pontchaillou,l Maxillo-Faciale, Rennes, Caen,m Caen, d'Angers,n Nantes,o ORL, AP HP URCEco ile-de-France,p hopital l'Hotel-Dieu, Paris, DRCI, departement Promotion,q France