Society of Black Academic Surgeons| Volume 211, ISSUE 4, P703-709, April 2016

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Demographics, disparities, and outcomes in substernal goiters in the United States

Published:January 05, 2016DOI:



      Disparities distinguishing patients with substernal goiters from nonsubsternal goiters have not been thoroughly described.


      The National Inpatient Sample database was used to compare patients who underwent substernal thyroidectomy years 2000 to 2010 with those who underwent thyroidectomy for nonsubsternal goiter.


      A total of 110,889 patients underwent thyroidectomy for goiter (5,525 substernal and 105,364 nonsubsternal). Substernal thyroidectomy patients were older, more likely to be Black or Hispanic and to have Medicare insurance. They had a higher comorbidity index, were more likely to be admitted emergently and to have postoperative complications such as hemorrhage/hematoma, pneumothorax, pulmonary embolism, and hypocalcemia/hypoparathyroidism. Furthermore, substernal thyroidectomy patients had 73% increased odds of death during admission than nonsubsternal thyroidectomy patients.


      Substernal goiters present a distinct type of goiter with identifiable patient-level characteristics and an increased risk of postoperative complications and death. Earlier identification and treatment of goiters may allow earlier interventions at a stage when risks are reduced.


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        • Hajhosseini B.
        • Montazeri V.
        • Hajhosseini L.
        • et al.
        Mediastinal goiter: a comprehensive study of 60 consecutive cases with special emphasis on identifying predictors of malignancy and sternotomy.
        Am J Surg. 2012; 203: 442-447
        • Abboud B.
        • Sleilaty G.
        • Mallak N.
        • et al.
        Morbidity and mortality of thyroidectomy for substernal goiter.
        Head Neck. 2010; 32: 744-749
        • Neves M.C.
        • Rosano M.
        • Hojaij F.C.
        • et al.
        A critical analysis of 33 patients with substernal goiter surgically treated by neck incision.
        Braz J Otorhinolaryngol. 2009; 75: 172-176
        • Pieracci F.M.
        • Fahey 3rd, T.J.
        Substernal thyroidectomy is associated with increased morbidity and mortality as compared with conventional cervical thyroidectomy.
        J Am Coll Surg. 2007; 205: 1-7
        • Huins C.T.
        • Georgalas C.
        • Mehrzad H.
        • et al.
        A new classification system for retrosternal goitre based on a systematic review of its complications and management.
        Int J Surg. 2008; 6: 71-76
        • Hardy R.G.
        • Bliss R.D.
        • Lennard T.W.
        • et al.
        Management of retrosternal goitres.
        Ann R Coll Surg Engl. 2009; 91: 8-11
        • Chen A.Y.
        • Bernet V.J.
        • Carty S.E.
        • et al.
        American thyroid association statement on optimal surgical management of goiter.
        Thyroid. 2014; 24: 181-189
        • Chen X.
        • Xu H.
        • Ni Y.
        • et al.
        Complete excision of a giant thyroid goiter in posterior mediastinum.
        J Cardiothorac Surg. 2013; 8: 207
        • Machado N.O.
        • Grant C.S.
        • Sharma A.K.
        • et al.
        Large posterior mediastinal retrosternal goiter managed by a transcervical and lateral thoracotomy approach.
        Gen Thorac Cardiovasc Surg. 2011; 59: 507-511
        • Kacprzak G.
        • Karas J.
        • Rzechonek A.
        • et al.
        Retrosternal goiter located in the mediastinum: surgical approach and operative difficulties.
        Interact Cardiovasc Thorac Surg. 2012; 15: 935-937
        • White M.L.
        • Doherty G.M.
        • Gauger P.G.
        Evidence-based surgical management of substernal goiter.
        World J Surg. 2008; 32: 1285-1300
        • Ben Nun A.
        • Soudack M.
        • Best L.A.
        Retrosternal thyroid goiter: 15 years experience.
        Isr Med Assoc J. 2006; 8: 106-109
        • Hashmi S.M.
        • Premachandra D.J.
        • Bennett A.M.
        • et al.
        Management of retrosternal goitres: results of early surgical intervention to prevent airway morbidity, and a review of the English literature.
        J Laryngol Otol. 2006; 120: 644-649
        • Hunt J.P.
        • Wilson M.
        • Buchmann L.O.
        Chylothorax associated with substernal goiter treated with transcervical thyroidectomy.
        Thyroid. 2011; 21: 551-553
        • Mack E.
        Management of patients with substernal goiters.
        Surg Clin North Am. 1995; 75: 377-394
        • Landerholm K.
        • Jarhult J.
        Should asymptomatic retrosternal goitre be left untreated? A prospective single-centre study.
        Scand J Surg. 2015; 104: 92-95
        • Coskun A.
        • Yildirim M.
        • Erkan N.
        Substernal goiter: when is a sternotomy required?.
        Int Surg. 2014; 99: 419-425
        • Casella C.
        • Pata G.
        • Cappelli C.
        • et al.
        Preoperative predictors of sternotomy need in mediastinal goiter management.
        Head Neck. 2010; 32: 1131-1135
        • Rolighed L.
        • Ronning H.
        • Christiansen P.
        Sternotomy for substernal goiter: retrospective study of 52 operations.
        Langenbecks Arch Surg. 2015; 400: 301-306
        • Raffaelli M.
        • De Crea C.
        • Ronti S.
        • et al.
        Substernal goiters: incidence, surgical approach, and complications in a tertiary care referral center.
        Head Neck. 2011; 33: 1420-1425
        • Shaha A.R.
        Substernal goiter: what is in a definition?.
        Surgery. 2010; 147: 239-240
        • Sancho J.J.
        • Kraimps J.L.
        • Sanchez-Blanco J.M.
        • et al.
        Increased mortality and morbidity associated with thyroidectomy for intrathoracic goiters reaching the carina tracheae.
        Arch Surg. 2006; 141: 82-85
        • Agha A.
        • Glockzin G.
        • Ghali N.
        • et al.
        Surgical treatment of substernal goiter: an analysis of 59 patients.
        Surg Today. 2008; 38: 505-511
        • Rios A.
        • Rodriguez J.M.
        • Balsalobre M.D.
        • et al.
        The value of various definitions of intrathoracic goiter for predicting intra-operative and postoperative complications.
        Surgery. 2010; 147: 233-238
        • Rugiu M.G.
        • Piemonte M.
        Surgical approach to retrosternal goitre: do we still need sternotomy?.
        Acta Otorhinolaryngol Ital. 2009; 29: 331-338
        • Chow T.L.
        • Chan T.T.
        • Suen D.T.
        • et al.
        Surgical management of substernal goitre: local experience.
        Hong Kong Med J. 2005; 11: 360-365