Release: Embargo until September 24, 2000Contact: Jennifer Felsher202-371-4517 (9/23-27)703-519-1549[email protected]
RESIDENTS TRAINED AT PUBLIC HOSPITAL HIGHLY PROFICIENT AT THYROID REMOVAL
Study at Baylor College of Medicine proves that residents training at a public hospital are equally skilled as senior specialists in excising a patient's thyroid
Washington, D.C. -- A recent study indicates that there is little difference in outcome when the thyroid is removed by a third-year otolaryngology--head and neck surgery resident when compared to a more senior specialist. Thyroid surgery is one of the most common procedures in the United States, with more than 75,000 being performed each year.
The study, "Thyroid Surgery: A Comparison of Outcomes Between Experts and Surgeons in Training," is authored by Masayoshi Takashima, MD, Spiros Manolidis, MD, Matthew Kirby, MD and Matthew Scarlett, MD, all from Baylor College of Medicine, Houston, TX. Dr. Takashima will present the findings Tuesday, September 26, at the American Academy of Otolaryngology -- Head and Neck Surgery Foundation's Annual Meeting/Oto Expo being held at the Washington, D.C. Convention Center.
Thyroid surgeries are performed by both general surgeons and otolaryngologist -- head and neck surgeons. Although the surgical procedure has an excellent safety record, any complications that may occur are of great concern to patients as they can be life threatening or cause long term debilitation.
Approximately 2-3 percent of all medico legal claims in general surgery are related to complications from thyroid surgery, even though the incidence of complications is uncommon. The findings presented in this study provide evidence that there is little difference between the outcome of a thyroid surgery performed by a third year resident and an experienced surgeon.
Methodology: The study was conducted by review of 1140 patient records compiled at the affiliated teaching hospitals of Baylor College of Medicine from 1986 to 1998. Of this number, 273 charts were deemed to be complete enough for the study. Criteria for inclusion were: detailed information regarding diagnostic studies, preoperative diagnosis based on these studies, operative variables, complications, length of hospital stay, and a 12 month follow-up (minimum).
Ninety-two consecutive thyroidectomy procedures were performed in a metropolitan public hospital (MPH) by otolaryngology -- head and neck surgery residents under supervision for three years (Group A). In a similar period of time, 181 thyroid operations were performed in a private hospital (PH) setting by the faculty of these residents (Group B). These two groups were retrospectively reviewed and compared for demographics, presenting symptoms and findings, diagnostic studies, types of surgery, surgical complications, and length of hospital stay.
The demographics of both groups were similar in age and sex. Symptoms at presentation were twice as common in Group A, while no differences were seen upon examination. Abnormalities of thyroid function were more prevalent in group B (34 percent versus six percent).
The results of diagnostic studies were comparable for both groups. However, patients in Group A were more than twice as likely to have had a thyroid scan preoperatively to assist in diagnosis.
Each case was managed with standard thyroid surgery techniques, which can be classified into four categories: total thyroidectomy, subtotal thyroidectomy (preservation of one superior pole), hemithyroidectomy, and total thyroidectomy with neck dissection. Group B had twice as many total thyroidectomies as Group A.
The incidences of surgical complications for each group were equal, with one patient in Group A requiring an emergency intubation and one patient in Group B requiring an emergency tracheotomy. Both patients had postoperative hematomas. Length of hospital stay was slightly longer in Group A (an average of 4.5 days) versus Group B (an average of 3.1).
Results: The demographic distribution of both groups was similar. Presenting symptoms were twice as frequent in the MPH group(Group A); however, examination findings were similar. More total thyroidectomies were performed in the PH group(Group B). Average blood loss, average operation time, and average hospital stay did not show any significant differences. Preoperative and intra operative diagnostic results showed sensitivities and specificities that were comparable. No permanent vocal cord paralysis was observed in either group. Permanent hypocalcemia was more frequent in the PH group (Group B), possibly due to the increased number of total thyroidectomies.
Conclusion: The results of thyroid surgery on similar populations performed by otolaryngology -- head and neck surgery residents in a metropolitan public hospital are similar to those of faculty in a private hospital. Surgeries performed by residents had similar lengths of time in the operating room, similar lengths of hospitalization, and similar, if not fewer, permanent complications than thyroid surgeries performed by experts.
-end-
RSS