A meta-analysis of intraoperative neuromonitoring of recurrent laryngeal nerve palsy during thyroid reoperations

Summary

Background

The rate of recurrent laryngeal nerve (RLN) palsy, a common complication of thyroid surgery, is especially high in thyroid reoperations. The present meta-analysis assesses whether intraoperative neuromonitoring (IONM) reduces the prevalence of RLN palsy in thyroid reoperations.

Design and methods

A systematic literature search was conducted in the PubMed, SCIE, and Wan Fang databases for studies published up to August 31, 2016. All data were analysed using STATA (version 11) software. Publication bias was assessed using Begg's funnel plot and Egger's test, and sensitivity analysis was performed.

Results

Nine studies including 2436 at-risk nerves met the inclusion criteria. The results were presented as pooled relative risks (RRs) with 95% confidence intervals (CI). The overall RLN palsy rate was significantly lower in reoperations conducted with IONM than in those conducted without IONM (RR = 0.434, 95% CI = 0.206–0.916, p = 0.029). High heterogeneity was found (I² = 70.2%, p = 0.001). The rates of transient RLN palsy with and without IONM did not differ significantly (RR = 0.607, 95% CI = 0.270–1.366, p = 0.227). The heterogeneity was high (I² = 67.4%, p = 0.005). However, IONM was significantly associated with a reduction in permanent RLN palsy (RR = 0.426, 95% CI = 0.196–0.925, p = 0.031). No significant heterogeneity was found (I² = 13.7%, p = 0.325). Funnel plots for overall and transient RLN palsy showed a possible publication bias.

Conclusions

IONM is associated with a reduction in overall and permanent RLN palsy in thyroid reoperations. However, given the limited sample size and heterogeneity in this meta-analysis, further studies are required to confirm our preliminary findings.

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