Complication Profile of Reoperative Thyroidectomy Versus First-Time Thyroidectomy: A Systematic Review and Meta-analysis.

INTRODUCTION: Reoperative thyroidectomy, defined as surgery for recurrent thyroid disease following prior thyroid resection, is widely perceived to carry a greater likelihood of complications than first-time thyroidectomy due to anatomic distortion and scar formation. Despite recognition of these challenges, the existing evidence is heterogeneous and lacks comprehensive synthesis. Thus, this meta-analysis aims to evaluate the comparative complication rates between reoperative and first-time thyroidectomy. METHODS: PubMed, Ovid Embase, Cochrane Library, CINAHL, Scopus, and Web of Science were searched from their respective inception dates to October 2025. The review was registered prospectively on the PROSPERO database (CRD420251158243). RESULTS: Twenty-three studies comprising 42,314 patients were included, of whom 4154 (9.8%) underwent reoperative thyroidectomy. Reoperative thyroidectomy was associated with greater odds of transient hypocalcemia (odds ratio [OR] = 1.53; 95% confidence interval [CI]: 1.06-2.20; I2 = 84%), permanent hypocalcemia (OR = 1.88; 95% CI: 1.33-2.67; I2 = 24%), transient recurrent laryngeal nerve (RLN) injury (OR = 2.57; 95% CI: 1.73-3.83; I2 = 72%), permanent RLN injury (OR = 3.94; 95% CI: 2.60-5.97; I2 = 47%), and hematoma (OR = 1.76; 95% CI: 1.12-2.78; I2 = 7%) when compared with first-time thyroidectomy. CONCLUSIONS: Reoperative thyroidectomy appears to carry a higher likelihood of complications than first-time thyroidectomy with an almost 4-fold increase in odds of permanent RLN injury. These findings emphasize the importance of appropriate patient counseling, careful patient selection, and clear clinical indications when considering reoperative thyroidectomy.