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Indian Journal of Surgery

, Volume 81, Issue 5, pp 432–438 | Cite as

Thyroidectomy Audit: Effects of Specialised, High Volume Work on Key Performance Indicators

  • Anish Jacob CherianEmail author
  • Siddhartha Chakravarthy
  • Noamaan Muhammed
  • Suchitra Chinadurai
  • Mahasampath Gowri
  • M. J. Paul
  • Deepak Thomas Abraham
Original Article
  • 26 Downloads

Abstract

We conducted this audit to assess and improve the quality of care for patients undergoing thyroid surgery at our institution. The audit process began in 2012. Key performance indicators assessed were rates of hypocalcemia (immediate postoperative, temporary and permanent), recurrent laryngeal nerve (RLN) injury, chyle leak rate, re-exploration for chyle leak and post-thyroidectomy haemorrhage. Data of patients undergoing thyroidectomy from 1st January to 31st December 2011 was retrospectively collected from the electronic database. Performance indicators were assessed and compared to international standards. Actions to correct the short falls were implemented and retrospective re-audits were performed on prospectively collected data in subsequent years until 2015. The data was analysed using STATA IC/13.1. There has been a steady increase in the number of thyroidectomies performed/year from 357 in 2011 to 577 in 2015. The most common procedure performed was total thyroidectomy (~70%) and histopathology revealed thyroid malignancy in the majority of patients. Over 5 years, a significant improvement in the rates of post-thyroidectomy immediate and temporary hypocalcemia was witnessed (p < 0.001) as well as a near significant fall in permanent hypocalcemia and RLN injury rate (p = 0.06). In 2014 and 2015, no patients were re-explored for a chyle leak. The rate of post-thyroidectomy haemorrhage (1.2–1.8%) has remained static over 5 years. This audit portrays specialisation in endocrine surgery and high volumes of patients treated have resulted in a significant improvement in outcomes for patients following thyroid surgery that meet international standards.

Keywords

Audit Thyroidectomy complications Hypocalcemia Recurrent laryngeal nerve injury Chyle leak 

Notes

Compliance with Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Informed Consent

For this type of study, formal consent is not required.

References

  1. 1.
    Roh J-L, Park J-Y, Park CI (2009) Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thyroid carcinoma undergoing total thyroidectomy plus central neck dissection. Cancer 115:251–258CrossRefGoogle Scholar
  2. 2.
    Lorente-Poch L, Sancho JJ, Muñoz-Nova JL, Sánchez-Velázquez P, Sitges-Serra A (2015) Defining the syndromes of parathyroid failure after total thyroidectomy. Gland Surg. 4:82–90PubMedPubMedCentralGoogle Scholar
  3. 3.
    Tredici P, Grosso E, Gibelli B, Massaro M, Arrigoni C, Tradati N (2011) Identification of patients at high risk for hypocalcemia after total thyroidectomy. Acta Otorhinolaryngol Ital 31:144–148PubMedPubMedCentralGoogle Scholar
  4. 4.
    Nair CG, Babu MJC, Menon R, Jacob P (2013) Hypocalcaemia following total thyroidectomy: an analysis of 806 patients. Indian J Endocrinol Metab 17:298–303CrossRefGoogle Scholar
  5. 5.
    Cherian AJ, Ramakant P, Paul TV, Abraham DT, Paul MJ (2016) Next-day parathyroid hormone as a predictor of post-thyroidectomy hypocalcemia. World J Endoc Surg 8:203–207CrossRefGoogle Scholar
  6. 6.
    Alhefdhi A, Mazeh H, Chen H (2013) Role of postoperative vitamin D and/or calcium routine supplementation in preventing hypocalcemia after thyroidectomy: a systematic review and meta-analysis. Oncologist 18:533–542CrossRefGoogle Scholar
  7. 7.
    Franch-Arcas G, González-Sánchez C, Aguilera-Molina YY, Rozo-Coronel O, Estévez-Alonso JS, Muñoz-Herrera Á (2015) Is there a case for selective, rather than routine, preoperative laryngoscopy in thyroid surgery? Gland Surg 4:8–18PubMedPubMedCentralGoogle Scholar
  8. 8.
    Chandrasekhar SS, Randolph GW, Seidman MD, Rosenfeld RM, Angelos P, Barkmeier-Kraemer J, Benninger MS, Blumin JH, Dennis G, Hanks J, Haymart MR, Kloos RT, Seals B, Schreibstein JM, Thomas MA, Waddington C, Warren B, Robertson PJ, American Academy of Otolaryngology-Head and Neck Surgery (2013) Clinical practice guideline: improving voice outcomes after thyroid surgery. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg 148:S1–S37Google Scholar
  9. 9.
    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L (2016) 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 26:1–133CrossRefGoogle Scholar
  10. 10.
    Fon LJ, Deans GT, Lioe TF, Lawson JT, Briggs K, Spence RAJ (1996) An audit of thyroid surgery in a general surgical unit. Ann R Coll Surg Engl 78:192–196PubMedPubMedCentralGoogle Scholar
  11. 11.
    Edafe O, Prasad P, Harrison BJ, Balasubramanian SP (2014) Incidence and predictors of post-thyroidectomy hypocalcaemia in a tertiary endocrine surgical unit. Ann R Coll Surg Engl 96:219–223CrossRefGoogle Scholar
  12. 12.
    Palma MD, Rosato L, Zingone F, Orlando G, Antonino A, Vitale M et al (2016) Post-thyroidectomy complications. The role of the device: bipolar vs ultrasonic device. Am J Surg 212:116–121CrossRefGoogle Scholar
  13. 13.
    Noureldine SI, Genther DJ, Lopez M, Agrawal N, Tufano RP (2014) Early predictors of hypocalcemia after total thyroidectomy. JAMA Otolaryngol-- Head Neck Surg 140:1006–1013CrossRefGoogle Scholar
  14. 14.
    Stack BC, Bimston DN, Bodenner DL, Brett EM, Dralle H, Orloff LA et al (2015) American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: postoperative hypoparathyroidism--definitions and management. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol 21:674–685Google Scholar
  15. 15.
    Lo C-Y, Kwok K-F, Yuen P-W (2000) A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy. Arch Surg 135:204–207CrossRefGoogle Scholar
  16. 16.
    Calò PG, Pisano G, Medas F, Pittau MR, Gordini L, Demontis R, Nicolosi A (2014) Identification alone versus intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery: experience of 2034 consecutive patients. J Otolaryngol - Head Neck Surg 43:16CrossRefGoogle Scholar
  17. 17.
    Lv B, Zhang B, Zeng Q-D (2016) Total endoscopic thyroidectomy with intraoperative laryngeal nerve monitoring. Int J Endocrinol 2016:e7381792CrossRefGoogle Scholar
  18. 18.
    Sun H, Tian W, Jiang K, Chiang F, Wang P, Huang T, et al. (2015) Clinical guidelines on intraoperative neuromonitoring during thyroid and parathyroid surgery. Ann Transl Med. [Internet]. [cited 2017 Nov 24];3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4583592/
  19. 19.
    Dionigi G, Wu C-W, Lombardi D, Accorona R, Bozzola A, Kim HY, Chiang FY, Bignami M, Castelnuovo P, Nicolai P (2014) The current state of recurrent laryngeal nerve monitoring for thyroid surgery. Curr Otorhinolaryngol Rep 2:44–54CrossRefGoogle Scholar
  20. 20.
    Malik R, Linos D (2016) Intraoperative neuromonitoring in thyroid surgery: a systematic review. World J Surg 40:2051–2058CrossRefGoogle Scholar
  21. 21.
    Gremillion G, Fatakia A, Dornelles A, Amedee RG (2012) Intraoperative recurrent laryngeal nerve monitoring in thyroid surgery: is it worth the cost? Ochsner J 12:363–366PubMedPubMedCentralGoogle Scholar
  22. 22.
    Brajcich BC, McHenry CR (2016) The utility of intraoperative nerve monitoring during thyroid surgery. J Surg Res 204:29–33CrossRefGoogle Scholar
  23. 23.
    Brennan PA, Blythe JN, Herd MK, Habib A, Anand R (2012) The contemporary management of chyle leak following cervical thoracic duct damage. Br J Oral Maxillofac Surg 50:197–201CrossRefGoogle Scholar
  24. 24.
    Ilczyszyn A, Ridha H, Durrani AJ (2011) Management of chyle leak post neck dissection: a case report and literature review. J Plast Reconstr Aesthetic Surg JPRAS 64:e223–e230CrossRefGoogle Scholar
  25. 25.
    Cherian A, Ramakant P, Paul MJ, Abraham DT (2015) Management of chyle leak in the neck following thyroid cancer surgery: a single centre experience. World J Endocr Surg 7:6–9CrossRefGoogle Scholar
  26. 26.
    Mayilvaganan S, Chekavar A, Kapoor R, Agarwal A (2015) Conservative management of chyle leak following thyroid surgery. World J Endoc Surg 7:76–78CrossRefGoogle Scholar
  27. 27.
    Shaha AR, Jaffe BM (1994) Practical management of post-thyroidectomy hematoma. J Surg Oncol 57:235–238CrossRefGoogle Scholar
  28. 28.
    Liu J, Sun W, Dong W, Wang Z, Zhang P, Zhang T, et al. (2017) Risk factors for post-thyroidectomy haemorrhage: a meta-analysis. Eur J Endocrinol. EJE-16-0757Google Scholar
  29. 29.
    Lee HS, Lee BJ, Kim SW, Cha YW, Choi YS, Park YH, Lee KD (2009) Patterns of post-thyroidectomy hemorrhage. Clin Exp Otorhinolaryngol 2:72–77CrossRefGoogle Scholar

Copyright information

© Association of Surgeons of India 2018

Authors and Affiliations

  1. 1.Department of Endocrine SurgeryChristian Medical College and HospitalVelloreIndia
  2. 2.Department of BiostatisticsChristian Medical College and HospitalVelloreIndia

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