Medical Malpractice Trends in Thyroidectomies among General Surgeons and Otolaryngologists

Abstract

Objectives This study aims to examine litigation trends with thyroidectomies in the United States from 1984 to 2018. Methods We used the Westlaw legal database to collect data on the defendant, plaintiff, case demographics, alleged reasons for malpractice, additional complications, and case outcomes. Results The most common reason for litigation was vocal cord paralysis (51%, n = 28), with the majority ruling in favor of the defendant (64%, P = .042). Of those, 43% of cases (n = 12) were due to unilateral recurrent laryngeal nerve (RLN) injury, and 39% (n = 11) were due to bilateral RLN injury. Of the claims due to vocal cord paralysis that resulted in indemnity payment (36%), the majority included additional damages, such as lack of informed consent (30%) or subsequent damages from permanent tracheostomy (40%), which is usually a result of bilateral nerve paralysis. Conclusion RLN injury was the most common complication leading to trial, with most cases ruling in favor of the defense. However, most verdicts that favored the plaintiff or those that settled were due to subsequent damages from bilateral nerve paralysis, such as permanent tracheostomy. We encourage surgeons to consider a staged procedure in high-risk cases or cases with signal loss. There needs to be a bigger emphasis on informed consent in the training of surgeons. Surgeons should educate patients at high risk on potential surgical complications that may drastically affect their quality of life.

Litigation in thyroid surgery: a pan-specialty review of National Health Service (UK) data

“…Litigation trends associated with thyroid surgery in the USA indicate that the most common claim was for vocal fold paralysis and the need for tracheostomy, with issues surrounding informed consent accounting for 30 per cent of claims. 8 Adjusting our data to surgical complications, we show similar results, where the most common injury cited was nerve injury (n = 8), for which two claims (25 per cent) included cause codes for 'failure to warninformed consent'. Our data concur with the most recent review of 161 cases in thyroid surgery in England by Dent and Bagnall, 9 who presented nerve injury as the most common surgical complication.…”

Multi-Omics and Management of Follicular Carcinoma of the Thyroid

“…An integration and concurrent analysis of findings from ultrasound and elastography, radioisotope scan and MRI is most likely going to increase the accuracy of predicting the likelihood of FTC. The extent of vascular or capsular invasion of the FTC into may also be determined without the need for an invasive biopsy or a costly and potentially risky diagnostic lobectomy [ 176 , 217 , 218 , 219 , 220 , 221 , 222 , 223 ] Radiomics enables segmentation of the tumor and facilitates a thorough analysis of the tumor and the TME [ 163 , 224 , 225 ].A thorough analysis of a thyroid nodule and the TME may enable a “virtual” biopsy of the lesion and accurate histological diagnosis and grading of the tumor, like what would be achieved following a tissue or liquid biopsy. Some of the imaging investigations, such as [ 18 F] FDG PET/CT and [ 18 F] FDG/MRI, can localize metastases from FTC when there is discordance between the serum Tg level and the results of a whole-body radioiodine scan (WBS) [ 72 , 131 , 142 , 226 ].…”

“…Other problems that can be addressed if AI is implemented is the incorrect risk-stratification of patients who have FTC and the appropriate level of TSH suppression in intermediate and high-risk patients. Additional benefits of AI is accurate calculation of I-131 dose for ablation, adjuvant therapy or treatment, a delay in the detection of progression, recurrence, and de-differentiation of the tumor, and prediction of the response to treatment [ 183 , 221 , 223 , 231 , 234 ]. The use of AI in the management of FTC can simultaneously incorporate background personal, life-style, and environmental factors (digital personal twin), imaging results (radiomics), FNAC and histological results (pathomics), mutational analysis (genomics), histone modification and transcriptomics (epigenomics), and post-translational changes (proteomics and metabolomics).…”

“…Fine needle aspiration cytology cannot distinguish FTC, FA, FVPTC, and other follicular-patterned lesions [ 215 ]. The application of AI can predict the diagnosis of cancer in a thyroid nodule that returned a Bethesda III or IV following FNAC [ 223 , 236 ]. The performance of AI-based technology sometimes surpasses that of less experienced radiologists, which would be useful in areas where resources are limited [ 236 , 237 , 238 ].…”

Thyroid Lobectomy for Low to Intermediate Risk Differentiated Thyroid Cancer

“…Secondly, many studies have now confirmed the long-term complications and consequences of thyroid surgery for patients and healthcare systems despite the use of modern technologies such as neuromonitoring. The rates of unilateral and bilateral recurrent nerve paralysis and the rate of permanent hypoparathyroidism remain stable and low at 1-2%, but this is responsible for significant morbidity from a patient perspective and is very costly on the scale of entire populations [6][7][8][9].…”