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Preoperative predictors of sternotomy need in mediastinal goiter management
Author(s) -
Casella Claudio,
Pata Giacomo,
Cappelli Carlo,
Salerni Bruno
Publication year - 2010
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.21303
Subject(s) - medicine , goiter , odds ratio , confidence interval , mediastinum , cardiothoracic surgery , radiology , receiver operating characteristic , median sternotomy , surgery , logistic regression , anterior mediastinum , aortic arch , thyroid , aorta
Background. The objective of this study was to identify the preoperative risk factors for patients in need of a sternotomy in the management of mediastinal goiters in order to provide better preoperative planning and patient consent.Methods. We analyzed 98 patients who underwent surgery for mediastinal goiters (goiters extending below the thoracic inlet ≥3 cm with the neck in hyperextension) between 1995 and 2008. Twelve (12.2%) of the patients required a sternotomy. The patients' features were analyzed by the surgical approach performed. Logistic regression analysis was used to study which variables were influencing the surgical strategy. The receiver operating characteristic (ROC) curves were designed when appropriate.Results. The analysis disclosed the following risk factors: radiologic extension of mediastinal goiters below the aortic arch (odds ratio [OR] = 32.87; 95% confidence interval [CI] = 4.04–267.12; p < .0001); posterior mediastinum involvement for mediastinal goiters with subaortic extension (OR = 7.2; 95% CI = 1.52–34.14; p = .0244); history of mediastinal goiters before surgery (for mediastinal goiters aged >160 months: OR = 22.8; 95% CI = 5.28–98.53; p < .0001).Conclusions. Sternotomy need for mediastinal goiter removal can be predicted; in such cases surgeons should not hesitate to perform it for minimizing complications. © 2009 Wiley Periodicals, Inc. Head Neck, 2010