Incidence of recurrent laryngeal nerve injury and associated risk factors after thyroidectomy: a retrospective study

BACKGROUND: Recurrent laryngeal nerve injury (RLNI) is a wellknown complication of thyroidectomy that can lead to vocal cord palsy (VCP). Identifying risk factors and reducing the incidence of RLNI are essential for improving surgical outcomes. OBJECTIVES: To assess the incidence of permanent VCP after thyroidectomy and evaluate its possible associated risk factors. DESIGN: A retrospective cohort study SETTING: A multicenter study conducted in Makkah, Saudi Arabia METHODS: The study assessed incidence of permanent RLNI and its associated risk factors in 314 patients who underwent thyroidectomy at our centers in Makkah, Saudi Arabia, between December 2014 and December 2024. The data were gathered on general characteristics, clinical findings, and surgical details. Statistical analyses were performed to identify significant risk factors. MAIN OUTCOMES MEASURES: Incidence of permanent RLNI and the associated risk factors. SAMPLE SIZE: 314 patients RESULTS: Overall incidence of permanent VCP was 9 (2.9%). The left vocal cord was affected in 3 (1%) of cases, while the right vocal cord was affected in 6 (1.9%). Significant risk factors included age over 45 years ( P =.043), male patients ( P =.04), prior thyroid surgery ( P =.006), and high cumulative doses of radioactive iodine ( P =.008). However, no significant associations with factors such as family history of thyroid disease, carcinoma, or incidental disease onset. CONCLUSION: Post-thyroidectomy VCP is influenced by several factors, including age, gender, previous thyroid surgery, and radioactive iodine dose. These findings highlight the importance of careful pre-operative risk assessment and the use of preventive measures, such as Intra-Operative Nerve monitoring, use of optical magnification and pre-operative predicting of thyroidectomy difficulty to reduce RLNI risk. LIMITATIONS: Possibility of selection bias due to the retrospective design. In addition to lack of use of certain analytical tests and detailed subgroup analysis due to the moderate sample size.