Risk Factors for Increased Drain Output After Endoscopic Thyroidectomy Via Areola Approach: a Retrospective Cohort Study

Background: Endoscopic thyroidectomy (ET) offers superior cosmetic outcomes compared to traditional open thyroidectomy but is associated with higher postoperative drainage volumes (DV) and potential complications. Although ET via the areola approach (ETAA) has been used, the factors influencing DV after ETAA remain poorly understood. Therefore, this study aimed to identify clinical parameters that can objectively evaluate the factors influencing drainage volume after ETAA.

Methods: This retrospective cohort study enrolled consecutive patients with thyroid disease who underwent ETAA at The First Affiliated Hospital of Jinan University between February and September 2016. After adjusting for potential confounders, univariate and ordinal logistic regression analyses determined the association between DV and clinical variables.

Results: We identified hyperthyroidism, operation time, and male gender as independent risk factors for increased DV. Specifically, hyperthyroidism was linked to higher DV across the first and second 24-hour periods [odds ratio (OR) =2.97, P=0.049], while longer operation times and male gender also significantly influenced DV (≤100 min: OR =0.11, P=0.02; >100, ≤150 min: OR =0.39, P=0.049; male gender OR =0.23, P=0.02). Notably, high DV in the second 24 hours predicted even higher DV in the third 24 hours (<30 mL: OR =0.04, P<0.001; 30-60 mL: OR =0.22, P=0.01). These findings suggest that patients with these risk factors should be closely monitored during ETAA, and postponing drain removal in patients with large DV in the early postoperative period may be warranted.

Conclusions: This study enhances our understanding of the factors affecting DV after ETAA and highlights the need for tailored postoperative care strategies.