Does resident involvement in thyroid surgery lead to increased postoperative complications?

Kshirsagar, Rijul S.; Chandy, Zachariah; Mahboubi, Hossein; Verma, Sunil P.

doi:10.1002/lary.26176

Cited by 22 publications

(18 citation statements)

References 31 publications

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“…There was not an increased overall or neurologic complication odds when a surgical trainee was involved. Kshirsagar et al [19] 2017 Resident participation in thyroid surgery was not associated with an increased 30-day postoperative complication rate. Folsom et al [20] 2017…”

Section: Survey Resultsmentioning

confidence: 96%

Training in endocrine surgery

Gimm

Barczyński

Mihai

et al. 2019

Langenbecks Arch Surg

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Background/purpose In Europe, the Division of Endocrine Surgery (DES) determines the number of operations (thyroid, neck dissection, parathyroids, adrenals, neuroendocrine tumors of the gastro-entero-pancreatic tract (GEP-NETs)) to be required for the European Board of Surgery Qualification in (neck) endocrine surgery. However, it is the national surgical boards that determine how surgical training is delivered in their respective countries. There is a lack of knowledge on the current situation concerning the training of surgical residents and fellows with regard to (neck) endocrine surgery in Europe. Methods A survey was sent out to all 28 current national delegates of the DES. One questionnaire was addressing the training of surgical residents while the other was addressing the training of fellows in endocrine surgery. Particular focus was put on the numbers of operations considered appropriate. Results For most of the operations, the overall number as defined by national surgical boards matched quite well the views of the national delegates even though differences exist between countries. In addition, the current numbers required for the EBSQ exam are well within this range for thyroid and parathyroid procedures but below for neck dissections as well as operations on the adrenals and GEP-NETs.Conclusions Training in endocrine surgery should be performed in units that perform a minimum of 100 thyroid, 50 parathyroid, 15 adrenal, and/or 10 GEP-NET operations yearly. Fellows should be expected to have been the performing surgeon of a minimum of 50 thyroid operations, 10 (central or lateral) lymph node dissections, 15 parathyroid, 5 adrenal, and 5 GEP-NET operations.

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Section: Survey Resultsmentioning

confidence: 96%

Training in endocrine surgery

Gimm

Barczyński

Mihai

et al. 2019

Langenbecks Arch Surg

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“…The role of residents and the balance between education and patient care represent unique challenges in the academic practice setting. For example, several studies of resident participation in the otolaryngology operating room have shown longer operating times in cases with resident participation, although there was no increase in complications or mortality . There is at least one prior study addressing the residents’ effect on patient satisfaction in the otolaryngology clinic.…”

Section: Discussionmentioning

confidence: 99%

“…For example, several studies of resident participation in the otolaryngology operating room have shown longer operating times in cases with resident participation, although there was no increase in complications or mortality. [20][21][22] There is at least one prior study addressing the residents' effect on patient satisfaction in the otolaryngology clinic. This large, cross-sectional study of Press Ganey surveys showed decreased patient satisfaction when residents were involved in the clinic visit (88.7% vs. 90.4%, P < .001).…”

Section: Discussionmentioning

confidence: 99%

Clinical scribes and their association with patient experience in the otolaryngology clinic

et al. 2019

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Objectives/Hypothesis Electronic health records have brought many advantages but also placed a documentation burden on the provider during and after the clinic visit. Some otolaryngologists have countered this challenge by employing clinical scribes. This project aimed to better understand the influence of scribes on patient experience in the otolaryngology clinic. Study Design Retrospective cohort survey study. Methods Patients presenting to the otolaryngology clinic for new and follow‐up appointments were recruited to complete surveys about their experience. Results A total of 153 patients completed the survey, and 96 of those patients (62.7%) interacted with a scribe. Patient satisfaction was not significantly associated with participation of the scribe (P = .668). Similarly, patient rating of their physician on a scale of 1 to 10 was not associated with scribe involvement (P = .851). The patients who did interact with a scribe responded that the scribe positively impacted the visit 77.1% of the time. Participation of a resident, primary language other than English, and use of interpreter were associated with lower satisfaction (P = .004, P < .001, and P < .001, respectively). Conclusions There are no published data on the effect of scribes on patient experience in the otolaryngology clinic. In other specialties, scribes have been demonstrated as having a positive effect on provider satisfaction, clinical productivity, and patient perception. These data demonstrate that patient satisfaction was neither impaired nor improved by the presence of the scribe in this clinic. In light of benefits demonstrated by prior studies, these findings support the conclusion that scribes are a useful adjunct in providing high‐level otolaryngology care. Level of Evidence 4 Laryngoscope, 130:E134–E139, 2020

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“…When assessing surgical times, increasing level of training was associated with significantly shorter tonsillectomy operative time; operative time for adenotonsillectomy was 9 minutes (range, 8-12) for attendings, 13 minutes (range, 10-17 minutes) for fellows, 14 minutes (range, [11][12][13][14][15][16][17][18] for residents, and 15 minutes (range, 12-20) for visiting residents (P < 0.001) (Table III). Similarly, when residents were stratified by level of training, increasing training level was associated with shorter surgical times.…”

Section: Surgical Timesmentioning

confidence: 99%

The impact of resident involvement on tonsillectomy outcomes and surgical time

et al. 2019

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Objective Posttonsillectomy hemorrhage can be life‐threatening, so we investigated whether patients are at increased risk with an inexperienced surgeon. There is scant information on how surgical experience affects outcomes in pediatric tonsillectomy. We hypothesized that supervised residents would have longer operative times but no difference in complication rates compared to attending surgeons. Study Design Retrospective case series of children who underwent tonsillectomy from July 2014 to April 2017 at a tertiary pediatric medical center. Methods We assessed outcomes and operative times, based on the primary surgeon's level of training, for children (14 months to 22 years) who underwent tonsillectomy. Results A total of 7,606 children were included (mean age 7.0 ± 4.1 years, 51% female) with a mean body mass index (BMI) of 18.6 ± 5.48 kg/m2; 76% were white; and 13% were black. Residents assisted with tonsillectomy in 43% of cases. The readmission rate (5%–6%) was not different (P = 0.48) by level of experience. Similarly, return to the operating room for control of hemorrhage (3.3%–3.5%) did not differ by level of experience (P = 0.95). The median procedure time for adenotonsillectomy was shortest for attendings (9 minutes), followed by fellows (13 minutes), and residents (14 minutes, P < 0.0001). Among residents, time for adenotonsillectomy decreased significantly with each increasing year of training (P < 0.0001) from postgraduate year (PGY) 1 (17 minutes), to PGY2 (15 minutes), to PGY3 (14 minutes), and to PGY4 (12.5 minutes). Conclusion Attending surgeons completed tonsillectomy more quickly, and operative times decreased with increasing experience level. However, there was no difference in readmission or postoperative hemorrhage rates between residents and attending surgeons. Level of Evidence 4 Laryngoscope, 130:2481–2486, 2020

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Does resident involvement in thyroid surgery lead to increased postoperative complications?

Abstract: 2C Laryngoscope, 127:1242-1246, 2017.

Cited by 22 publications

References 31 publications

Training in endocrine surgery

Training in endocrine surgery

Clinical scribes and their association with patient experience in the otolaryngology clinic

The impact of resident involvement on tonsillectomy outcomes and surgical time

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