Objective:

To determine the frequency of temporary and permanent recurrent laryngeal nerve injury (RLNI) after thyroid operations and identify influencing surgical and patient-related factors.

Key Findings:

• Transient RLNI was most frequent after completion thyroidectomy (10%, 95% CI, 4–16%) and hemithyroidectomy (8%, 95% CI, 1–15%), least after near-total thyroidectomy (2%, 95% CI, 1–3%).
• Transoral and transcervical approaches had the highest transient RLNI rates (5%, 95% CI, 3–6%), while transaxillary had the lowest (1%, 95% CI, 1–2%).
• Permanent RLNI was highest in secondary thyroidectomy (2%, 95% CI, 1–3%).
• Surgical approach, intraoperative nerve monitoring (IONM), hemostasis method, drain use, and patient age were significant determinants of RLNI risk.

Interpretation:

Completion and revision surgeries, along with certain surgical approaches, significantly increase the risk of RLNI, highlighting the need for tailored surgical techniques to mitigate this risk.

Limitations:

• Variability in definitions of RLNI across studies may affect comparability.
• Potential publication bias in the included studies.
• Study heterogeneity may impact the generalizability of the findings.

Conclusion:

Optimizing surgical techniques and intraoperative strategies is essential to minimize the risk of recurrent laryngeal nerve injury during thyroid surgery.