Journal of Southern Medical University ›› 2025, Vol. 45 ›› Issue (11): 2511-2517.doi: 10.12122/j.issn.1673-4254.2025.11.24
Lihong CHEN1,2(
), Yafen CHEN1,2(), Huilin XIE1,2, Yancheng HUANG1,2, Yabin HUANG1,2, Sanqing JIN1,2()
Received:2025-08-10
Online:2025-11-20
Published:2025-11-28
Contact:
Sanqing JIN
E-mail:chenlihn@mail.sysu.edu.cn;chenyf399@mail.sysu.edu.cn;jinsq@mail.sysu.edu.cn
Lihong CHEN, Yafen CHEN, Huilin XIE, Yancheng HUANG, Yabin HUANG, Sanqing JIN. Intubaiton with electromyographic endotracheal tube increases risks of postoperative sore throat following thyroidectomy under general anesthesia: a retrospective cohort study[J]. Journal of Southern Medical University, 2025, 45(11): 2511-2517.
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URL: https://www.j-smu.com/EN/10.12122/j.issn.1673-4254.2025.11.24
| Variable | Before PSM | After PSM | ||||
|---|---|---|---|---|---|---|
| EMG group (n=100) | CWR group (n=145) | P | EMG group (n=90) | CWR group (n=75) | P | |
| Age (year) | 44.31±13.15 | 46.18±12.96 | 0.271 | 44.87±12.99 | 45.44±13.88 | 0.785 |
| BMI (kg/m²) | 24.05±4.24 | 24.19±4.42 | 0.804 | 24.20±4.28 | 24.21±5.32 | 0.989 |
| Height (cm) | 161.38±8.05 | 159.26±20.07 | 0.318 | 160.95±7.82 | 158.74±19.62 | 0.329 |
| Weight (kg) | 62.85±13.12 | 63.24±13.02 | 0.816 | 62.95±13.32 | 62.87±14.89 | 0.972 |
| Gender (n, %) | 0.697 | 0.658 | ||||
| Male | 22 (22.00) | 35 (24.14) | 19 (21.11) | 18 (24.00) | ||
| Female | 78 (78.00) | 110 (75.86) | 71 (78.89) | 57 (76.00) | ||
| Preoperative diagnosis (n, %) | 0.037 | 0.813 | ||||
| Hashimoto's thyroiditis | 1 (1.00) | 0 (0.00) | 0 (0.00) | 0 (0.00) | ||
| Thyroid mass | 87 (87.00) | 112 (77.24) | 80 (88.89) | 64 (85.33) | ||
| Thyroid nodule | 10 (10.00) | 31 (21.38) | 9 (10.00) | 10 (13.33) | ||
| Hyperthyroidism | 2 (2.00) | 2 (1.38) | 1 (1.11) | 1 (1.33) | ||
| ASA physical status (n, %) | 0.073 | 0.806 | ||||
| Class I | 14 (14.00) | 10 (6.90) | 10 (11.11) | 6 (8.00) | ||
| Class II | 82 (82.00) | 125 (86.21) | 77 (85.56) | 67 (89.33) | ||
| Class III | 3 (3.00) | 10 (6.90) | 3 (3.33) | 2 (2.67) | ||
| Class IV | 1 (1.00) | 0 (0.00) | ||||
| Comorbidities (n, %) | 0.380 | 0.652 | ||||
| None | 87 (87.00) | 119 (82.07) | 77 (85.56) | 66 (88.00) | ||
| Hypertension | 7 (7.00) | 18 (12.41) | 7 (7.78) | 5 (6.67) | ||
| Diabetes | 4 (4.00) | 3 (2.07) | 4 (4.44) | 1 (1.33) | ||
| Hyperthyroidism | 2 (2.00) | 5 (3.45) | 2 (2.22) | 3 (4.00) | ||
| Surgical approach (n, %) | 0.715 | 0.756 | ||||
| Transoral endoscopic | 3 (3.00) | 2 (1.38) | 3 (3.33) | 1 (1.33) | ||
| Transaxillary endoscopic | 7 (7.00) | 11 (7.59) | 6 (6.67) | 5 (6.67) | ||
| Open surgery | 90 (90.00) | 132 (91.03) | 81 (90.00) | 69 (92.00) | ||
| Extent of thyroidectomy (n, %) | <0.001 | 0.113 | ||||
| Total thyroidectomy | 20 (20.00) | 66 (45.52) | 19 (21.11) | 24 (32.00) | ||
| Subtotal thyroidectomy | 80 (80.00) | 79 (54.48) | 71 (78.89) | 51 (68.00) | ||
| Preoperative voice change (n, %) | 0.892 | 0.873 | ||||
| Yes | 1 (1.00) | 3 (2.07) | 1 (1.11) | 2 (2.67) | ||
| No | 99 (99.00) | 142 (97.93) | 89 (98.89) | 73 (97.33) | ||
| Intraoperative steroid use (n, %) | 0.403 | 0.140 | ||||
| No | 80 (80.00) | 122 (84.14) | 70 (77.78) | 65 (86.67) | ||
| Yes | 20 (20.00) | 23 (15.86) | 20 (22.22) | 10 (13.33) | ||
| Postoperative budesonide dose (mg) | 6.00 (4.00, 6.00) | 6.00 (6.00, 8.00) | 0.003 | 6.00 (4.00, 6.00) | 6.00 (4.00,8.00) | 0.372 |
Tab.1 Baseline characteristics of patients in the two groups before and after propensity score matching (PSM)
| Variable | Before PSM | After PSM | ||||
|---|---|---|---|---|---|---|
| EMG group (n=100) | CWR group (n=145) | P | EMG group (n=90) | CWR group (n=75) | P | |
| Age (year) | 44.31±13.15 | 46.18±12.96 | 0.271 | 44.87±12.99 | 45.44±13.88 | 0.785 |
| BMI (kg/m²) | 24.05±4.24 | 24.19±4.42 | 0.804 | 24.20±4.28 | 24.21±5.32 | 0.989 |
| Height (cm) | 161.38±8.05 | 159.26±20.07 | 0.318 | 160.95±7.82 | 158.74±19.62 | 0.329 |
| Weight (kg) | 62.85±13.12 | 63.24±13.02 | 0.816 | 62.95±13.32 | 62.87±14.89 | 0.972 |
| Gender (n, %) | 0.697 | 0.658 | ||||
| Male | 22 (22.00) | 35 (24.14) | 19 (21.11) | 18 (24.00) | ||
| Female | 78 (78.00) | 110 (75.86) | 71 (78.89) | 57 (76.00) | ||
| Preoperative diagnosis (n, %) | 0.037 | 0.813 | ||||
| Hashimoto's thyroiditis | 1 (1.00) | 0 (0.00) | 0 (0.00) | 0 (0.00) | ||
| Thyroid mass | 87 (87.00) | 112 (77.24) | 80 (88.89) | 64 (85.33) | ||
| Thyroid nodule | 10 (10.00) | 31 (21.38) | 9 (10.00) | 10 (13.33) | ||
| Hyperthyroidism | 2 (2.00) | 2 (1.38) | 1 (1.11) | 1 (1.33) | ||
| ASA physical status (n, %) | 0.073 | 0.806 | ||||
| Class I | 14 (14.00) | 10 (6.90) | 10 (11.11) | 6 (8.00) | ||
| Class II | 82 (82.00) | 125 (86.21) | 77 (85.56) | 67 (89.33) | ||
| Class III | 3 (3.00) | 10 (6.90) | 3 (3.33) | 2 (2.67) | ||
| Class IV | 1 (1.00) | 0 (0.00) | ||||
| Comorbidities (n, %) | 0.380 | 0.652 | ||||
| None | 87 (87.00) | 119 (82.07) | 77 (85.56) | 66 (88.00) | ||
| Hypertension | 7 (7.00) | 18 (12.41) | 7 (7.78) | 5 (6.67) | ||
| Diabetes | 4 (4.00) | 3 (2.07) | 4 (4.44) | 1 (1.33) | ||
| Hyperthyroidism | 2 (2.00) | 5 (3.45) | 2 (2.22) | 3 (4.00) | ||
| Surgical approach (n, %) | 0.715 | 0.756 | ||||
| Transoral endoscopic | 3 (3.00) | 2 (1.38) | 3 (3.33) | 1 (1.33) | ||
| Transaxillary endoscopic | 7 (7.00) | 11 (7.59) | 6 (6.67) | 5 (6.67) | ||
| Open surgery | 90 (90.00) | 132 (91.03) | 81 (90.00) | 69 (92.00) | ||
| Extent of thyroidectomy (n, %) | <0.001 | 0.113 | ||||
| Total thyroidectomy | 20 (20.00) | 66 (45.52) | 19 (21.11) | 24 (32.00) | ||
| Subtotal thyroidectomy | 80 (80.00) | 79 (54.48) | 71 (78.89) | 51 (68.00) | ||
| Preoperative voice change (n, %) | 0.892 | 0.873 | ||||
| Yes | 1 (1.00) | 3 (2.07) | 1 (1.11) | 2 (2.67) | ||
| No | 99 (99.00) | 142 (97.93) | 89 (98.89) | 73 (97.33) | ||
| Intraoperative steroid use (n, %) | 0.403 | 0.140 | ||||
| No | 80 (80.00) | 122 (84.14) | 70 (77.78) | 65 (86.67) | ||
| Yes | 20 (20.00) | 23 (15.86) | 20 (22.22) | 10 (13.33) | ||
| Postoperative budesonide dose (mg) | 6.00 (4.00, 6.00) | 6.00 (6.00, 8.00) | 0.003 | 6.00 (4.00, 6.00) | 6.00 (4.00,8.00) | 0.372 |
| Variable | EMG group (n=90) | CWR group (n=75) | P |
|---|---|---|---|
| Duration of surgery (min) | 85.41±33.35 | 102.79±38.96# | 0.002 |
| Duration of anesthesia (min ) | 152.47±37.89 | 152.28±41.51 | 0.976 |
| Postoperative hospital stay (day) | 3.31±1.15 | 3.64±0.98 | 0.052 |
| Sore throat after surgery (n, %) | 17 (18.89) | 2 (2.67)# | 0.001 |
| Incisional pain after surgery (n, %) | 66 (73.33) | 58 (77.33) | 0.554 |
| Recurrent laryngeal nerve injury (n, %) | 0 (0.00) | 0 (0.00) | - |
| Postoperative voice change (n, %) | 5 (5.75) | 3 (4.05) | 0.921 |
Tab.2 Intraoperative and postoperative outcomes of the patients in the two groups
| Variable | EMG group (n=90) | CWR group (n=75) | P |
|---|---|---|---|
| Duration of surgery (min) | 85.41±33.35 | 102.79±38.96# | 0.002 |
| Duration of anesthesia (min ) | 152.47±37.89 | 152.28±41.51 | 0.976 |
| Postoperative hospital stay (day) | 3.31±1.15 | 3.64±0.98 | 0.052 |
| Sore throat after surgery (n, %) | 17 (18.89) | 2 (2.67)# | 0.001 |
| Incisional pain after surgery (n, %) | 66 (73.33) | 58 (77.33) | 0.554 |
| Recurrent laryngeal nerve injury (n, %) | 0 (0.00) | 0 (0.00) | - |
| Postoperative voice change (n, %) | 5 (5.75) | 3 (4.05) | 0.921 |
| Variable | Univariate analysis | Multivariate analysis | ||
|---|---|---|---|---|
| OR (95% CI) | P | OR (95% CI) | P | |
| Age (year) | 1.00 (0.97-1.04) | 0.948 | - | - |
| Female (Ref: Male) | 2.68 (0.59-12.18) | 0.202 | - | - |
| BMI (kg/m²) | 0.97 (0.86-1.09) | 0.583 | - | - |
| Preoperative diagnosis (Ref: Thyroid mass) | ||||
| Thyroid nodule | 0.89 (0.19-4.17) | 0.878 | - | - |
| Hyperthyroidism | 0.00 (0.00-Inf) | 0.993 | - | - |
| EMG tube (Ref: CWR tube) | 8.50 (1.90-38.12) | 0.005 | 17.56 (2.26-136.52) | 0.006 |
| Surgical approach (Ref: Transoral) | ||||
| Transaxillary | 0.67 (0.04-10.25) | 0.771 | - | - |
| Open surgery | 0.36 (0.04-3.68) | 0.390 | - | - |
| Subtotal thyroidectomy(vs total) | 0.99 (0.33-2.92) | 0.979 | - | - |
| Operation time (min) | 1.00 (0.99-1.01) | 0.910 | - | - |
| Anesthesia duration (min) | 1.00 (0.99-1.02) | 0.549 | - | - |
| Intraoperative steroid use (Ref: No) | 0.50 (0.11-2.27) | 0.366 | - | - |
| Postoperative budesonide dose (mg) | 1.23 (1.01-1.50) | 0.047 | 1.24 (1.01-1.52) | 0.046 |
Tab 3 Univariate and multivariate logistic regression analysis of the factors associated with postoperative sore throat
| Variable | Univariate analysis | Multivariate analysis | ||
|---|---|---|---|---|
| OR (95% CI) | P | OR (95% CI) | P | |
| Age (year) | 1.00 (0.97-1.04) | 0.948 | - | - |
| Female (Ref: Male) | 2.68 (0.59-12.18) | 0.202 | - | - |
| BMI (kg/m²) | 0.97 (0.86-1.09) | 0.583 | - | - |
| Preoperative diagnosis (Ref: Thyroid mass) | ||||
| Thyroid nodule | 0.89 (0.19-4.17) | 0.878 | - | - |
| Hyperthyroidism | 0.00 (0.00-Inf) | 0.993 | - | - |
| EMG tube (Ref: CWR tube) | 8.50 (1.90-38.12) | 0.005 | 17.56 (2.26-136.52) | 0.006 |
| Surgical approach (Ref: Transoral) | ||||
| Transaxillary | 0.67 (0.04-10.25) | 0.771 | - | - |
| Open surgery | 0.36 (0.04-3.68) | 0.390 | - | - |
| Subtotal thyroidectomy(vs total) | 0.99 (0.33-2.92) | 0.979 | - | - |
| Operation time (min) | 1.00 (0.99-1.01) | 0.910 | - | - |
| Anesthesia duration (min) | 1.00 (0.99-1.02) | 0.549 | - | - |
| Intraoperative steroid use (Ref: No) | 0.50 (0.11-2.27) | 0.366 | - | - |
| Postoperative budesonide dose (mg) | 1.23 (1.01-1.50) | 0.047 | 1.24 (1.01-1.52) | 0.046 |
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