{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T19:50:03Z","timestamp":1791575403581,"version":"4.3.4"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"41","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10,9]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Intraoperative neuromonitoring (IONM) is commonly used during thyroid surgery to facilitate recurrent laryngeal nerve (RLN) identification and potentially reduce related postoperative complications. However, the efficacy of routine IONM in decreasing complication rates remains debated. In this study, we investigated the impact of IONM on postoperative complications after thyroidectomy. This retrospective single-center study included 214 thyroidectomy operations performed between 2021 and 2024. Patients were divided into 2 groups: Group 1 (n\u2005=\u2005107) underwent surgery with routine IONM, and Group 2 (n\u2005=\u2005107) without IONM, using only conventional direct visualization. Postoperative complications (RLN palsy, hypocalcemia, hypoparathyroidism, and incidental parathyroidectomy) were compared between groups. The primary outcome was any RLN palsy, analyzed at the nerve level. Prespecified propensity score matching and sensitivity analyses were also performed. Preoperative calcium levels were higher in Group 1 than in Group 2 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2005=\u2005.002). Postoperative calcium and parathyroid hormone levels and the rates of hypocalcemia and hypoparathyroidism did not differ between the groups; the smallest\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      value across these outcomes was.04 before and.40 after adjustment for multiplicity. There were 198 nerves at risk in Group 1 and 204 in Group 2. Any RLN palsy occurred in 3\/198 nerves (1.5%) in Group 1 and 2\/204 (1.0%) in Group 2 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2005=\u2005.68). Transient RLN palsy occurred in 3\/198 (1.5%) and 1\/204 (0.5%), respectively (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2005=\u2005.37), whereas permanent RLN palsy occurred in 0\/198 (0%) and 1\/204 (0.5%), respectively (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2005&gt;\u2005.99). No difference in any RLN palsy was observed in the propensity score\u2013matched cohort (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2005&gt;\u2005.99), and comparable findings were observed in the pre specified sub cohort and sensitivity analyses. Routine IONM was not associated with a significant reduction in RLN palsy, hypocalcemia, or hypoparathyroidism compared with conventional direct visualization. The very small number of RLN events and the wide confidence intervals indicate limited statistical precision, and the study was not sufficiently powered to exclude clinically meaningful differences in the risk of RLN palsy.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/md.0000000000051068","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T19:01:09Z","timestamp":1791572469000},"page":"e51068","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["The effect of routine intraoperative neuromonitoring on thyroidectomy complications"],"prefix":"10.1097","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3937-825X","authenticated-orcid":false,"given":"Huseyin Emre","family":"Arslan","sequence":"first","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bercis Imge","family":"Ucar","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sezgin","family":"Zeren","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Cihat","family":"Yildirim","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet Fatih","family":"Ekici","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ozlem","family":"Arik","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa Cem","family":"Algin","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Eskisehir City Hospital, Eskisehir, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"suppl 1","key":"R1-20261009","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s12893-019-0483-y","article-title":"Postoperative hypocalcemia: analysis of factors influencing early hypocalcemia development following thyroid surgery.","volume":"18","author":"Del Rio","year":"2019","journal-title":"BMC Surg"},{"key":"R2-20261009","first-page":"9","article-title":"Factors affecting postoperative hypocalcemia after thyroid surgery: importance of incidental parathyroidectomy.","volume":"3","author":"Ozemir","year":"2016","journal-title":"North Clin Istanb"},{"key":"R3-20261009","doi-asserted-by":"crossref","first-page":"187","DOI":"10.2147\/IJGM.S204795","article-title":"Design of a predictive score to assess the risk of developing hypocalcemia after total thyroidectomy: a retrospective study.","volume":"12","author":"Papanastasiou","year":"2019","journal-title":"Int J Gen Med"},{"key":"R4-20261009","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.amsu.2018.04.032","article-title":"Hypocalcemia after thyroidectomy: iPTH levels and iPTH decline are predictive? A retrospective cohort study.","volume":"30","author":"Cannizzaro","year":"2018","journal-title":"Ann Med Surg (Lond)"},{"key":"R5-20261009","doi-asserted-by":"crossref","first-page":"225","DOI":"10.4183\/aeb.2019.225","article-title":"First day serum calcium and parathyroid hormone levels as predictive factors for safe discharge after thyroidectomy.","volume":"15","author":"Sala","year":"2019","journal-title":"Acta Endocrinol (Buchar)"},{"key":"R6-20261009","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1177\/014556131309200814","article-title":"Post-thyroidectomy early serum ionic calcium level: predictor of prolonged hypocalcemia.","volume":"92","author":"Nemade","year":"2013","journal-title":"Ear Nose Throat J"},{"key":"R7-20261009","doi-asserted-by":"crossref","first-page":"318","DOI":"10.14310\/horm.2002.1283","article-title":"Complications and risk factors related to the extent of surgery in thyroidectomy. Results from 2,043 procedures.","volume":"9","author":"Karamanakos","year":"2010","journal-title":"Hormones (Athens)"},{"key":"R8-20261009","doi-asserted-by":"crossref","first-page":"e6674","DOI":"10.1097\/MD.0000000000006674","article-title":"Recurrent laryngeal nerve injury after thyroid and parathyroid surgery: incidence and postoperative evolution assessment.","volume":"96","author":"Joliat","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"R9-20261009","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.ijsu.2017.01.086","article-title":"Systematic review with meta-analysis of intraoperative neuromonitoring during thyroidectomy.","volume":"39","author":"Yang","year":"2017","journal-title":"Int J Surg"},{"key":"R10-20261009","first-page":"14","article-title":"Effect of nerve monitoring on complications of thyroid surgery.","volume":"5","author":"Demiryas","year":"2018","journal-title":"North Clin Istanb"},{"key":"R11-20261009","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.otorri.2017.06.005","article-title":"Recommendations on the use of neuromonitoring in thyroid and parathyroid surgery.","volume":"69","author":"Pardal-Refoyo","year":"2018","journal-title":"Acta Otorrinolaringol Esp (Engl Ed)"},{"key":"R12-20261009","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1016\/j.surg.2015.04.041","article-title":"Transient and permanent hypocalcemia after total thyroidectomy: early predictive factors and long-term follow-up results.","volume":"158","author":"Seo","year":"2015","journal-title":"Surgery"},{"issue":"suppl 3","key":"R13-20261009","first-page":"S1","article-title":"International neural monitoring study group guideline 2018 part I: Staging bilateral thyroid surgery with monitoring loss of signal.","volume":"128","author":"Schneider","year":"2018","journal-title":"Laryngoscope"},{"key":"R14-20261009","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1002\/(SICI)1097-0258(19980430)17:8<873::AID-SIM779>3.0.CO;2-I","article-title":"Interval estimation for the difference between independent proportions: comparison of eleven methods.","volume":"17","author":"Newcombe","year":"1998","journal-title":"Stat Med"},{"key":"R15-20261009","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1080\/00273171.2011.568786","article-title":"An introduction to propensity score methods for reducing the effects of confounding in observational studies.","volume":"46","author":"Austin","year":"2011","journal-title":"Multivariate Behav Res"},{"key":"R16-20261009","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1002\/pst.433","article-title":"Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies.","volume":"10","author":"Austin","year":"2011","journal-title":"Pharm Stat"},{"key":"R17-20261009","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1002\/sim.3697","article-title":"Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.","volume":"28","author":"Austin","year":"2009","journal-title":"Stat Med"},{"key":"R18-20261009","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1002\/(SICI)1097-0258(19980430)17:8<891::AID-SIM780>3.0.CO;2-B","article-title":"Equivalence test and confidence interval for the difference in proportions for the paired-sample design.","volume":"17","author":"Tango","year":"1998","journal-title":"Stat Med"},{"key":"R19-20261009","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1016\/j.jclinepi.2014.03.012","article-title":"False discovery rate control is a recommended alternative to Bonferroni-type adjustments in health studies.","volume":"67","author":"Glickman","year":"2014","journal-title":"J Clin Epidemiol"},{"key":"R20-20261009","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.3390\/jpm13101429","article-title":"Intraoperative neuromonitoring does not reduce the risk of temporary and definitive recurrent laryngeal nerve damage during thyroid surgery: a systematic review and meta-analysis of endoscopic findings from 73,325 nerves at risk.","volume":"13","author":"Cozzi","year":"2023","journal-title":"J Pers Med"},{"key":"R21-20261009","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1001\/jamaoto.2024.4452","article-title":"Progress and outcomes of intraoperative nerve monitoring during thyroidectomy.","volume":"151","author":"Hearn","year":"2025","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"R22-20261009","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1007\/s12070-023-03615-6","article-title":"Intra operative recurrent laryngeal nerve monitering during thyroid surgery - is it worth?","volume":"75","author":"Ojha","year":"2023","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"key":"R23-20261009","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1002\/bjs.6417","article-title":"Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy.","volume":"96","author":"Barczy\u0144ski","year":"2009","journal-title":"Br J Surg"},{"key":"R24-20261009","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1016\/j.amjsurg.2021.10.013","article-title":"Nerve monitoring decreases recurrent laryngeal nerve injury risk for neoplasm-related thyroidectomy.","volume":"223","author":"Duong","year":"2022","journal-title":"Am J Surg"},{"key":"R25-20261009","doi-asserted-by":"crossref","first-page":"388","DOI":"10.47391\/JPMA.10752","article-title":"Does intraoperative neuro monitoring during thyroidectomy reduce the risk of hypoparathyroidism?","volume":"75","author":"Keklikkiran","year":"2025","journal-title":"J Pak Med Assoc"}],"container-title":["Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/MD.0000000000051068","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T19:01:13Z","timestamp":1791572473000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/MD.0000000000051068"}},"subtitle":["A propensity score-matched retrospective cohort study"],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":25,"journal-issue":{"issue":"41","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/md.0000000000051068","relation":{},"ISSN":["0025-7974","1536-5964"],"issn-type":[{"value":"0025-7974","type":"print"},{"value":"1536-5964","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]},"assertion":[{"value":"2025-11-13","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-23","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}