The most frequent surgical complications in thyroid surgery are chordal palsy, hypocalcemia and bleeding. These conditions present an high rate of variability among different case series, and the identification of risk and protective factors for the development of these complications is still being studied.

We retrospectively analyzed thyroid surgical procedures performed in Varese Hospital from April 2019 to June 2022, in order to define the incidence and the predictive factors of postoperative complications. All procedures were performed using intraoperative neuromonitoring (IONM).

Among 470 patients (236 men and 234 women with a mean age of 30 years) postoperative hypocalcemia (defined as serum values <8.5mg/dL) was found in 189 patients (40.2%), only 1.4% have permanent hypocalcemia. Risk factors related to hypocalcemia were bilateral procedure (p<0.001), antiplatelet therapy (p=0.035), anticoagulant drugs and malignant histology. We found 28 (5.9%) LOS (lost of signal), compared with postoperative chordal motility deficits in 26 patients (5.5%). The only risk factor related with LOS is lymphadenectomy (p<0.001). The need of re-cervicotomy for hemostasis occurred in 13 patients (2.7%). Female sex (p<0.001), previous neck surgery (p<0.001), total thyroidectomy (p<0.001), and age (p=0.012) appear to be risk factors for hemostatic re-cervicotomy.

With a few exceptions, the data from our study are, with a few exceptions, in line with the mainly meta-analytic literature. Systematic use of IONM, advanced hemostasis, and high center volume are determinants in reducing complications in thyroid surgery.