Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Thyroid surgery can affect quality of life, with risks of hoarseness and hypocalcemia as key concerns. Patient-Reported Outcomes (PRO) using Memorial Sloan Kettering Cancer Centers remote symptom monitoring (RMS) platform, Recovery Tracker, captures these outcomes and offer real-world insights.
Methods: In this retrospective cohort study, thyroid surgery patients at MSKCC’s Josie Robertson Ambulatory Surgery Center (Sept 2016 - June 2022) used the Recovery Tracker, an ePROs RSM platform, to report symptoms over 10 days. Symptom severity for hoarseness and numbness was tracked by post-operative day and procedure. A multivariable model identified predictors of these symptoms.
Results: Among 1,912 patients assigned surveys, 1,620 patients responded (84% response rate), 76% were female, median age 48 (IQR 35-59). The median number of responses was 6 (IQR 2-8). Surgery types included thyroid lobectomy (68%), total thyroidectomy (12%), and total thyroidectomy with neck dissection (20%). The median operative time was 112 minutes (IQR 89-139). Among survey responders, 616 patients responded to surveys on hoarseness; on post-operative day one, 87% reported hoarseness (46% mild, 32% moderate, 9% severe or very severe). By post-operative day five, 59% reported hoarseness (47% mild, 11% moderate, 1.5% severe or very severe). By post-operative day ten no patients reported hoarseness. Total thyroidectomy patients reported higher severe hoarseness on day one (12%) than lobectomy patients (5.7%, p=0.017) however severity levels generally decreased thereafter with no significant differences observed between the two groups days 2-10. In multivariable analysis, moderate to severe hoarseness decreased over number of post operative days (OR = 0.54, p < 0.001); males had lower odds than females (OR = 0.38, p = 0.020). Increasing age (OR = 1.03, p = 0.014) and longer operative time (OR = 1.02, p < 0.001) were associated with higher odds of persistent hoarseness. Among 382 patients reporting numbness, 32% reported it on day one (23% mild, 6% moderate, 3% severe). By post-operative day five, 8% reported numbness (6% mild, 2% moderate, no severe or very severe symptoms reported). By post operative day ten no patients reported numbness. Numbness severity was not significantly associated with parathyroid hormone level; total thyroidectomy patients had higher early numbness (p < 0.05). On multivariable analysis, only the number of days post-operatively was associated with moderate to severe numbness; odds decreased over time (OR = 0.69, 95% CI [0.58, 0.83], p < 0.001).
Conclusion: Hoarseness and numbness are common post-operatively but typically resolve by day 10. This study provides a clear view of symptom progression, aiding in patient education and setting realistic recovery expectations.