Abstract
Introduction
Thyroid surgery is a common procedure for managing benign and malignant conditions. While the primary focus is on treating the underlying pathology, visible neck scars can significantly impact patients’ self-esteem and quality of life (QoL). A comprehensive assessment of scar cosmesis alongside functional outcomes is essential. Despite the availability of tools such as the Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS), studies combining subjective and objective scar assessments with thyroid-specific and general QoL measures remain limited.
Methodology
This retrospective study evaluated scar cosmesis and QoL in 100 thyroidectomy patients treated between January 2021 and December 2023. Subjective satisfaction was measured using the Visual Analog Scale (VAS), and objective assessments were performed using VSS and POSAS. QoL was assessed using validated instruments, ThyPRO and SF-36, to capture thyroid-specific and general QoL domains. Statistical analyses included t-tests, Pearson correlation, and multivariate regression.
Results
The mean VAS score was 7.8, with 85% of patients reporting satisfaction with their scars. Objective evaluations yielded mean VSS and POSAS scores of 5.2 and 6.8, respectively. Younger patients (VAS = 8.2 for ≤ 50 years) and females (VAS = 8.0) reported higher satisfaction with scar outcomes. QoL improved significantly, with physical functioning increasing from 65.3 to 76.8 (p < 0.01) and emotional well-being from 61.2 to 70.1 (p < 0.05). Significant correlations were observed between scar cosmesis scores and QoL domains, such as physical functioning (r = 0.42). Sensory changes, including numbness around the scar area, were reported in 12% of patients.
Conclusion
Integrating subjective and objective measures, including ThyPRO and SF-36, provides a complete evaluation of scar cosmesis and QoL outcomes after thyroidectomy. Key predictors of higher satisfaction included younger age, female gender, and superior scar quality. These findings highlight the importance of addressing both aesthetic and functional outcomes in thyroid surgery to enhance patient satisfaction and QoL.
Supplementary Information
The online version contains supplementary material available at 10.1007/s12070-025-05368-w.
Keywords: Thyroidectomy, Scar cosmesis, Quality of life, Vancouver Scar Scale, Patient and Observer Scar Assessment Scale, ThyPRO, SF-36
Introduction
Thyroid surgery is a widely performed procedure for the treatment of benign and malignant thyroid conditions. While the primary focus of these surgeries is on the effective management of the underlying pathology, the cosmetic outcomes, particularly the visible scar on the neck, remain a significant concern for patients. Scarring in such a prominent area can affect body image and self-esteem, which in turn influences overall quality of life (QoL) [1]. Consequently, understanding the relationship between scar cosmesis and QoL is an important aspect of evaluating postoperative outcomes [2].
Traditionally, scar assessment has relied on subjective patient-reported measures, which provide valuable insights into patient satisfaction but may lack standardization and objectivity. Tools such as the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS) offer a more structured evaluation of scar characteristics, including pigmentation, texture, and pliability [3]. Scars located in highly visible areas, like the neck, can have significant psychosocial implications, influencing both aesthetic perception and functional recovery [4]. Despite this, studies integrating subjective and objective assessments of scar outcomes, especially in thyroid surgery, remain limited [5].
This retrospective study focuses on assessing scar cosmesis and QoL in patients who underwent thyroid surgery. By integrating subjective and objective measures, this study aims to provide a deeper understanding of scar outcomes and their impact on long-term patient satisfaction. The findings are expected to contribute to improving surgical practices and optimizing postoperative care to enhance patient-centered outcomes.
Methodology
Study Design
This study was a retrospective cohort analysis conducted to evaluate scar cosmesis and quality of life (QoL) outcomes in patients who underwent thyroid surgery between January 2021 and December 2023. Scar cosmesis and QoL data were extracted from patient medical records, which included pre-documented follow-up assessments conducted during routine clinical care.
Study Population
A total of 100 patients who underwent thyroid surgery during the study period were included. These patients were selected based on predefined inclusion and exclusion criteria to ensure the reliability and relevance of the dataset.
Inclusion Criteria
Patients who underwent open thyroid surgery during the specified period.
Availability of complete medical records, including preoperative and follow-up documentation.
Follow-up duration of at least 6 months post-surgery, allowing for adequate scar maturation.
Exclusion Criteria
Patients with incomplete medical records or missing follow-up data.
Individuals who underwent additional surgeries or procedures involving the neck region post-thyroidectomy.
Cases with significant postoperative complications affecting scar healing (e.g., infection, hypertrophic scarring).
Data Collection
Data were collected retrospectively from medical records. This included:
Demographic Information Age, gender, and comorbidities (Supplement: S1: Data Collection Patient Demography & Surgical outcome).
Surgical Details Extent of surgery (partial or total thyroidectomy) and postoperative outcomes (Supplement: S1: Data Collection Patient Demography & Surgical outcome).
Subjective Scar Cosmesis Assessed using a Visual Analog Scale (VAS), where patients rated their satisfaction with scar appearance on a scale from 0 to 10. VAS scores were derived from follow-up consultations recorded in medical records. (Supplement: S2: Subjective Scar Cosmesis Data Collection Sheet).
Quality of Life Assessment Evaluated using ThyPRO & SF-36 Health Survey. These scores were documented during routine follow-ups or retrospectively obtained through patient-reported surveys (Supplement: Integrated ThyPRO and SF-36 Quality of Life Data Collection Sheet)
Objective Scar Assessment Conducted using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS), which measured scar characteristics such as pigmentation, texture, and pliability (Supplement: S4: Objective Scar Assessment Data Collection Sheet).
Postoperative Sensory Changes Clinical evaluations documented sensory changes, including numbness or discomfort around the scar area (Supplement: S5: Postoperative Sensory Changes Data Collection Sheet).
All scar assessments were conducted at least 6 months postoperatively to ensure adequate time for scar maturation.
Study Variables
Independent Variables Demographic data (e.g., age, gender) and psychosocial factors, alongside surgical details such as the extent of thyroidectomy.
Dependent Variables Scar cosmesis scores (VAS, VSS, POSAS), QoL outcomes (ThyPRO & SF-36), and the presence of sensory changes.
Statistical Analysis
Descriptive statistics were used to summarize demographic and clinical characteristics. Comparative analyses were performed using t-tests or ANOVA to evaluate differences in outcomes between patient groups. Pearson or Spearman correlation analyses were conducted to explore relationships between scar cosmesis scores and QoL outcomes. Multivariate regression analyses were used to identify predictors of scar satisfaction and QoL outcomes, considering factors such as age, gender, and psychosocial characteristics.
Ethical Considerations
Ethical approval for this study was obtained from the Institutional Review Board (IRB). For retrospective data analysis, a waiver of consent was granted, as all patient data were de-identified and anonymized to ensure confidentiality. For participants completing additional quality-of-life questionnaires (e.g., ThyPRO, SF-36), written informed consent was obtained to ensure compliance with ethical standards and respect for patient autonomy.
Results
Patient Demographics
The study cohort consisted of 100 patients who underwent thyroidectomy. The mean age of the participants was 45.6 years, with a predominance of female patients, accounting for 78% of the sample. The mean follow-up duration was 12.4 months, ensuring that all evaluations, including scar assessments, were conducted after adequate scar maturation (Fig. 1).
Fig. 1.
Patient demographics
Surgical Outcomes
Sixty percent of the cohort underwent hemi-thyroidectomy, while 40% underwent total thyroidectomy. The overall complication rate was 5%, with the most common complications including transient hypocalcaemia and minor wound infections, none of which required additional surgical intervention and resolved with conservative management (Fig. 2).
Fig. 2.
Surgical outcomes
Subjective Scar Cosmesis
The mean Visual Analog Scale (VAS) score for subjective scar cosmesis was 7.8 out of 10, indicating high levels of satisfaction with scar appearance. All VAS scores were recorded during routine follow-ups conducted at least 6 months post-surgery. Overall, 85% of patients reported being satisfied with their postoperative scar outcomes (Fig. 3).
Fig. 3.
Subjective scar cosmesis
Objective Scar Assessment
The objective assessment of scar appearance revealed a mean Vancouver Scar Scale (VSS) score of 5.2, indicating moderate scar quality. The mean Patient and Observer Scar Assessment Scale (POSAS) score was 6.8, reflecting a balanced evaluation of scar characteristics from both patient and clinician perspectives. Scar assessments were performed at a minimum of 6 months postoperatively to allow for scar maturation and stability (Fig. 4).
Fig. 4.
Objective scar assessment
Quality of Life Outcomes
Quality of Life Assessment (ThyPRO and SF-36 Domains)
The study found significant postoperative improvements in key quality-of-life domains. Physical functioning scores improved from 65.3 to 76.8 (p < 0.01), and pain scores increased from 55.6 to 74.5 (p < 0.01), reflecting enhanced daily activity levels and reduced discomfort. Fatigue scores decreased from 62.3 to 47.6 (p < 0.01), and cosmetic concerns improved from 65.3 to 52.2 (p < 0.01), indicating better energy levels and higher satisfaction with scar appearance. Emotional well-being increased from 61.2 to 70.1 (p < 0.05), and social functioning scores rose from 58.4 to 68.9 (p < 0.05), highlighting reduced psychological distress and better social integration. Overall health perception improved significantly from 57.3 to 72.1 (p < 0.01), demonstrating the positive impact of thyroidectomy on both thyroid-specific and general quality-of-life outcomes (Table 1).
Table 1.
Quality of life assessment (ThyPRO and SF-36 domains)
| Domain | Preoperative score | Postoperative score | p-value |
|---|---|---|---|
| Physical functioning | 65.3 | 76.8 | < 0.01 |
| Pain | 55.6 | 74.5 | < 0.01 |
| Fatigue | 62.3 | 47.6 | < 0.01 |
| Cosmetic concerns | 65.3 | 52.2 | < 0.01 |
| Emotional well-being | 61.2 | 70.1 | < 0.05 |
| Social functioning | 58.4 | 68.9 | < 0.05 |
| Overall, health | 57.3 | 72.1 | < 0.01 |
Postoperative Sensory Changes
Postoperative sensory changes were observed in 12% of patients, primarily as mild numbness around the scar area, and 8% reported discomfort. These sensory alterations were transient and typically resolved without intervention during the follow-up period, suggesting minimal impact on overall patient satisfaction with surgical outcomes (Fig. 5).
Fig. 5.
Postoperative sensory changes
Influence of Demographic and Psychosocial Factors
The analysis of demographic factors revealed differences in scar cosmesis perceptions across age and gender groups. Patients aged 50 years or younger reported higher mean VAS scores for scar satisfaction (8.2) compared to those over 50 years (7.5). Similarly, female patients reported greater satisfaction with their scar appearance, with a mean VAS score of 8.0, compared to 7.4 for male patients. These findings suggest that younger individuals and female patients perceive scar outcomes more favourably, highlighting demographic influences on subjective scar satisfaction (Table 2).
Table 2.
Demographic influence on scar cosmesis
| Demographic group | Thyroidectomy (N = 100) |
|---|---|
| Age > 50 years (mean VAS) | 7.5 |
| Age ≤ 50 years (mean VAS) | 8.2 |
| Female patients (mean VAS) | 8.0 |
| Male patients (mean VAS) | 7.4 |
Predictors of Scar Satisfaction and QoL
The multivariate regression analysis identified several significant predictors of scar satisfaction and quality of life (QoL). Increasing age was associated with lower scar satisfaction, as indicated by a negative β coefficient of − 0.28 (p < 0.05). Female gender positively influenced scar satisfaction, with a β coefficient of 0.34 (p < 0.01). Objective measures of scar quality, including improved Vancouver Scar Scale (VSS) scores (β = 0.42, p < 0.01) and improved Patient and Observer Scar Assessment Scale (POSAS) scores (β = 0.38, p < 0.01), were also strong predictors of higher scar satisfaction and better QoL outcomes. These findings underscore the interplay between demographic factors and objective scar assessments in determining patient satisfaction and QoL (Table 3).
Table 3.
Predictors of scar satisfaction and QoL
| Predictor | β coefficient | p-value |
|---|---|---|
| Age (per year increase) | − 0.28 | < 0.05 |
| Female gender | 0.34 | < 0.01 |
| Improved VSS score | 0.42 | < 0.01 |
| Improved POSAS score | 0.38 | < 0.01 |
Correlation Between Scar Cosmesis and QoL
The correlation analysis revealed significant associations between scar cosmesis and quality of life (QoL) outcomes as measured by the SF-36. Higher Visual Analog Scale (VAS) scores for subjective scar satisfaction were moderately correlated with improved physical functioning (r = 0.42, p < 0.01) and emotional well-being (r = 0.38, p < 0.01). Objective measures of scar cosmesis also demonstrated significant correlations; superior Vancouver Scar Scale (VSS) scores were associated with enhanced social functioning (r = 0.36, p < 0.01), while better Patient and Observer Scar Assessment Scale (POSAS) scores correlated positively with overall QoL improvements (r = 0.40, p < 0.01). These findings highlight the multidimensional impact of scar outcomes on patients' postoperative QoL, reflecting the importance of both subjective perceptions and objective assessments (Table 4).
Table 4.
Correlation between scar cosmesis and QoL
| Correlation analysis | r-value | p-value |
|---|---|---|
| VAS and physical functioning | 0.42 | < 0.01 |
| VAS and emotional well-being | 0.38 | < 0.01 |
| VSS and social functioning | 0.36 | < 0.01 |
| POSAS and overall QoL | 0.40 | < 0.01 |
Discussion
Principal Findings
This study evaluated scar cosmesis and quality of life (QoL) outcomes in patients who underwent thyroidectomy. Subjective assessments using the Visual Analog Scale (VAS) indicated high patient satisfaction, with a mean score of 7.8. Objective evaluations using the Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) revealed moderate scar quality. Scar assessments conducted at least 6 months postoperatively ensured accurate evaluation following scar maturation. Younger age, female gender, and better objective scar scores were identified as predictors of higher satisfaction and improved QoL. Mild and transient postoperative sensory changes were observed in 12% of patients, with 8% reporting discomfort; these symptoms resolved during follow-up without significant impact on overall satisfaction. Significant correlations were found between scar cosmesis and various domains of QoL as assessed by the SF-36, underscoring the impact of aesthetic outcomes on overall well-being.
Comparison with Existing Literature
The findings of this study align with and expand upon existing literature. Previous research has highlighted the significant psychological and social impact of scar outcomes in thyroidectomy patients. A study by Linos et al. demonstrated that health-related QoL and scar cosmesis are critical determinants of satisfaction due to the prominence of neck scars in thyroidectomy patients [6]. This study confirms those findings and adds depth by integrating objective assessments such as the VSS and POSAS, addressing a limitation of studies reliant solely on subjective evaluations.
Nguyen et al. emphasized the importance of standardized tools for assessing cosmetic outcomes in thyroid surgery, reinforcing the validity of this study’s methodology [7]. The use of such validated tools in this study ensures a comprehensive evaluation of scar quality and its broader implications on QoL. Furthermore, the analysis of demographic factors aligns with the findings of Sethukumar et al., who reported that younger and female patients tend to express higher satisfaction with scar appearance, highlighting the role of patient-specific characteristics in providing postoperative experiences [8].
This study’s observations on sensory changes corroborate the findings of Zhou et al., who reported transient sensory alterations in 12–15% of patient’s post-thyroidectomy, emphasizing the need for follow-up care that addresses these symptoms [5]. The strong correlation between scar cosmesis and QoL outcomes in this study mirrors observations made by Yount and Sturgeon, who highlighted that neck appearance significantly influences physical, emotional, and social domains in thyroid cancer survivors [9].
The inclusion of comprehensive QoL measures, such as the ThyPRO & SF-36, strengthens the findings. Similar to Xuan et al., who compared QoL outcomes in patients undergoing different thyroidectomy techniques, this study underscores the broader impact of surgical outcomes on patient well-being [10]. Together, these findings bridge the gap between aesthetic outcomes and their tangible effects on QoL.
Clinical Implications
The results of this study highlight the importance of addressing both aesthetic and functional outcomes in thyroid surgery. Preoperative counselling should incorporate discussions about scar appearance, sensory changes, and patient-specific factors such as age and gender, particularly for younger and female patients who may have higher expectations. Integrating objective assessments, such as the VSS and POSAS, into routine practice can standardize evaluations and guide interventions to improve scar outcomes. Additionally, follow-up care that prioritizes QoL domains, including physical functioning and emotional well-being, can significantly enhance patient satisfaction and long-term outcomes.
Strengths of the Study
The strengths of this study include its comprehensive methodology, which integrates subjective and objective measures of scar cosmesis. The use of validated tools such as the VSS, POSAS, ThyPRO, and SF-36 enhances the reliability and generalizability of the findings. The focus on demographic factors and sensory variables provides insights into predictors of patient satisfaction, supporting targeted clinical interventions.
Limitations of the Study
As a retrospective study, this work is limited by its reliance on medical records and patient recall, which may introduce bias. The relatively small sample size (N = 100) and single-center design may limit the generalizability of the findings. Additionally, variables such as nutritional status, suture material, and specific postoperative scar management interventions were not evaluated, which may influence outcomes. Future studies should address these factors to provide a more comprehensive understanding of scar cosmesis and QoL.
Future Directions
Future research should focus on prospective, multicentre studies with larger cohorts to validate these findings. Investigating the role of targeted interventions, such as silicone gel therapy or laser treatments, in improving scar outcomes would be valuable. Additionally, studies exploring cultural and social variations in scar perceptions and their psychosocial impact could further enhance patient-centered care strategies.
Conclusion
This study highlights the impact of scar cosmesis on quality of life in thyroidectomy patients. The integration of subjective and objective assessments provides a comprehensive framework for evaluating postoperative outcomes. The findings underscore the need for personalized approaches to preoperative counselling and postoperative care, particularly for younger and female patients who may have heightened expectations. Future research should build on these results to further refine surgical and postoperative strategies, ultimately enhancing patient satisfaction and well-being.
Supplementary Information
Below is the link to the electronic supplementary material.
Abbreviations
- QoL
Quality of life
- VAS
Visual Analog Scale
- VSS
Vancouver Scar Scale
- POSAS
Patient and Observer Scar Assessment Scale
- ThyPRO
Thyroid Patient-Reported Outcome Questionnaire
- SF-36
Short Form-36 Health Survey
- IRB
Institutional Review Board
Funding
No funding was received to assist with the preparation of this manuscript.
Declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Informed consent
Informed consent was taken from the patient wherever required.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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