Predictors of post-operative complications following thyroid surgeries at a tertiary hospital in Tanzania

Abstract

Background: Thyroid disorders pose a substantial burden in low- and middle-income countries (LMICs), where late presentation and limited access to specialized care often result in advanced disease at surgery. Despite thyroidectomy being the definitive treatment for many thyroid conditions, data on surgical outcomes and complication rates from sub-Saharan Africa remain scarce. This study aimed to describe the clinical characteristics, surgical approaches, and in-hospital postoperative outcomes of patients undergoing thyroidectomy at a tertiary hospital in Tanzania, and to identify factors associated with postoperative complications. Materials and Methods: This was a hospital-based retrospective cohort study involving patients who underwent thyroid surgery between January 2018 and December 2023. Data were retrieved from case notes and surgical records in the hospital's medical records department. Sociodemographic and clinical characteristics were analyzed as predictor variables, while postoperative in-hospital complications were the primary outcomes. Multivariable logistic regression was performed to identify independent predictors of complications. Results: A total of 405 patients underwent thyroidectomy during the study period, with a female predominance (89.6%) and a mean age of 48 ± 13 years. The majority presented with anterior neck swelling (98.5%), and 24% had retrosternal extension. Benign pathology accounted for 77% of cases. The overall complication rate was 15.3%, with hypocalcemia (4%) and superior laryngeal nerve injury (3%) being the most common. The mortality rate was 0.5%. Independent predictors of in-hospital complications included total thyroidectomy (aOR: 3.12; 95% CI: 1.08-9.02) and symptom duration exceeding 10 years (aOR: 4.12; 95% CI: 1.60-10.58). Conclusion: Postoperative morbidity following thyroidectomy in this setting was primarily driven by delayed presentation and the extent of surgery. Targeted interventions to promote early diagnosis and optimize perioperative care are essential to improve patient outcomes.