Impact of resident training on operative time and safety in hemithyroidectomy

Folsom, Craig; Serbousek, Kimberly; Lydiatt, William M.; Rieke, Katherine; Sayles, Harlan; Smith, Russell; Panwar, Aru

doi:10.1002/hed.24742

Cited by 12 publications

(12 citation statements)

References 33 publications

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“…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: 99%

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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“…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: 99%

Training in endocrine surgery

Gimm

Barczyński

Mihai

et al. 2019

Langenbecks Arch Surg

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“…15,17 However, in a different study of cases from the NSQIP database, performed over a 7-year period, resident participation in hemithyroidectomy was associated with increased procedure duration, increased wound complications, and higher rates of readmission. 18 A previous study of 3,922 procedures over 5 years found that resident participation during tonsillectomy led to increased operative times 19 ; however, these authors did not examine the impact of resident involvement on complications. The findings from our study agree with theirs regarding longer surgical times and addressed the question of complications with our finding that resident involvement did not lead to increased complications.…”

Section: Discussionmentioning

confidence: 99%

“…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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“…The involvement of resident trainees has been shown to be associated with increased operative times for several surgeries, including total thyroidectomy and lobectomy. [21][22][23][24][25][26][27] This discrepancy may also suggest further progression is possible beyond the initial point of proficiency and plateau, although further investigation is needed as multiple factors may be involved. Similar differences are found in comparing other studies, with reported mean OT ranging from 60 to 265 min.…”

Section: Discussionmentioning

confidence: 99%

“…One reason for this may be the nature of our hospital as a tertiary training institution, with junior or senior resident involvement in the vast majority of our cases. The involvement of resident trainees has been shown to be associated with increased operative times for several surgeries, including total thyroidectomy and lobectomy 21‐27 . This discrepancy may also suggest further progression is possible beyond the initial point of proficiency and plateau, although further investigation is needed as multiple factors may be involved.…”

Section: Discussionmentioning

confidence: 99%

Predictive model of operative time in transoral endoscopic thyroidectomy vestibular approach

et al. 2020

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Background: Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) has demonstrated excellent safety and is receiving wider use in North America. Understanding which factors lead to operative difficulty, as evaluated by operative time (OT), may help to improve safety and refine indications for this procedure. Methods: Cases of TOETVA performed at our institution were reviewed. Multivariate linear regression was performed using patient demographics, thyroid characteristics, and operative variables to predict OT. Results: A total of 207 cases were included for analysis. A multivariate linear regression model, controlling for age, sex, and BMI, was developed from 104 cases with an R 2 of 0.47 (p < 0.001). Cross-validation on 103 remaining cases showed root-mean-square error of 46.37. Total thyroidectomy and lobe size were the only significant predictors (p < 0.001). Conclusions: We successfully developed a model to predict OT for TOETVA based on preoperative and operative variables. Lobe size, but not BMI, is a significant predictor of OT.

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Impact of resident training on operative time and safety in hemithyroidectomy

Abstract: Resident participation in hemithyroidectomy may be associated with increased operative duration, higher incidence of wound complications, and readmission. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1212-1217, 2017.

Cited by 12 publications

References 33 publications

Training in endocrine surgery

Training in endocrine surgery

The impact of resident involvement on tonsillectomy outcomes and surgical time

Predictive model of operative time in transoral endoscopic thyroidectomy vestibular approach

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