Abstract
Background: Thyroid surgery encompasses procedures of widely varying technical complexity, and the operative risk carried by an individual patient is determined by far more than the diagnostic label alone. Contemporary guidance increasingly favours individualised selection of operative extent over a uniform strategy, but a practical gap remains between identifying isolated risk factors in the literature and applying them prospectively at the point of surgical planning. Objective: o evaluate the clinical feasibility and outcomes of a predefined risk-stratified approach to thyroid surgery at two tertiary-care centres, with particular reference to postoperative surgical morbidity, functional outcomes and disease control. Methods: In this prospective multicentre observational study, consecutive adults undergoing thyroid surgery for benign or malignant disease at two tertiary-care teaching hospitals in India were classified preoperatively into low-, intermediate- or high-risk categories using a predefined Thyroid Surgical Risk Score incorporating disease-related, anatomical, patient-related, functional and technical domains. The assigned category guided selection of the least extensive procedure judged adequate for disease control. The primary outcome was postoperative surgical morbidity across the three categories. Secondary outcomes were the relationship between risk category and operative extent, voice and swallowing function, thyroid functional status, thyroid-specific quality of life, completion or revision surgery, and, in malignant disease, pathological indicators of oncological adequacy. Participants were followed for 12 months. Results: Of 142 patients, 61 (43.0%) were at low risk, 52 (36.6%) intermediate risk and 29 (20.4%) high risk. Surgical complexity increased progressively across risk categories. Overall postoperative morbidity was 6.6%, 17.3% and 34.5% in the low-, intermediate- and high-risk groups, respectively. Mean VHI-10 improved from 9.6 ± 4.8 to 4.1 ± 2.7, while mean ThyPRO score improved from 48.3 ± 12.5 to 27.6 ± 10.4 at 12 months. Among patients with differentiated thyroid carcinoma, clear margins were achieved in 34/38 (89.5%). Completion or revision surgery was required in 7 (4.9%) patients. Conclusion: A predefined risk-stratified approach to thyroid surgery was operationally feasible across two centres. Interpretation of the relationship between preoperative risk category, surgical complexity and postoperative morbidity awaits the completed dataset. Because the design is observational and the risk framework has not been externally validated, the findings should be read as an evaluation of clinical feasibility rather than as validation of a predictive instrument.
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