Neuropsychiatric outcomes following conventional vs. Minimally invasive thyroid surgery: A nationwide population-based study of 469,729 patients

초록

Background: While minimally invasive thyroid surgery (MIS), including endoscopic (ET) and robotic thyroidectomy (RT), offers superior cosmetic outcomes, its long-term impact on neuropsychiatric disorders (NPDs) compared to conventional open thyroidectomy (COT) remains unclear. Objective: To compare the incidence of postoperative NPDs between COT and MIS (ET/RT) using a large-scale nationwide cohort. Methods: We conducted a retrospective cohort study using the Korean National Health Insurance Service database (2006–2022). A total of 469,729 adults undergoing thyroidectomy for neoplasms were identified. To ensure incident outcomes, a 4-year preoperative washout period was applied. Outcomes included cognitive disorders (MCI, dementia), mood disorders (depression, bipolar disorder), and anxiety. We used Cox proportional hazards models adjusted for age group, sex, and economic status (Model 3) to account for baseline differences. Results: Of the patients, 88.99% (n=418,033) underwent COT and 11.01% (n=51,696) underwent MIS. MIS patients were generally younger and more frequently female. Within 1 year, MIS was associated with significantly lower odds of anxiety (aOR 0.823, 95% CI 0.774–0.875) and depression (aOR 0.864, 95% CI 0.803– 0.929). Over a mean follow-up of 9.1 years, MIS showed lower hazards for MCI (aHR 0.894), dementia (aHR 0.860), anxiety (aHR 0.909), and depression (aHR 0.962). Notably, the hazard for bipolar disorder was higher in the MIS group (aHR 1.112, 95% CI 1.025–1.207), particularly in the RT subgroup. Conclusion: MIS was associated with a reduced risk of most neuropsychiatric outcomes, potentially due to higher cosmetic satisfaction and reduced psychosocial distress regarding scarring. However, the increased hazard for bipolar disorder suggests a need for careful psychiatric monitoring in specific subgroups. These findings emphasize the importance of considering long-term mental health in the surgical management of thyroid neoplasms.