Skip to main content
SpringerLink
Log in

Education in thyroid surgery: a matched-pair analysis comparing residents and board-certified surgeons

  • ORIGINAL ARTICLE
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Resident participation in operative procedures is mandatory in educational residency programs but remains controversial, especially in the context of patient safety. This study compared the surgical quality and outcomes of thyroidectomies performed by surgical residents (RESs) and board-certified surgeons (BCSs).

Methods

This retrospective matched-pair study included patients undergoing thyroidectomies for multinodular goiter, Grave’s disease and early-stage thyroid cancer that were performed by a RES with BCS supervision between 2006 and 2014. The intraoperative and postoperative course, complication rates and handling of the recurrent laryngeal nerve (RLN) and parathyroid glands were analyzed.

Results

In total, 112 thyroidectomies that were performed by a RES fulfilled the inclusion criteria and were matched 1:1 with BCS patients. We included 88 hemithyroidectomies, 80 subtotal thyroidectomies and 56 total thyroidectomies. No significant differences in the handling of the RLN or parathyroid glands, the rates of postoperative RLN palsies or the rates of hypocalcaemia were found. No intraoperative complications led to the replacement of the RES as the surgeon-in-charge. Three RES and two BCS patients experienced postoperative haemorrhages (p = 0.205), and three surgical site infections (p = 1.000) occurred in each group. The mean operative time and the length of stay did not differ significantly between the two groups.

Conclusions

Major aspects of patient safety in thyroid surgery are not affected by resident participation. Thyroidectomies performed by RES are not significantly longer and reveal no differences in length of stay or complication rates. The economic burden of resident involvement is modest.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Porta CR, Sebesta JA, Brown TA, Steele SR, Martin MJ (2012) Training surgeons and the informed consent process: routine disclosure of trainee participation and its effect on patient willingness and consent rates. Arch Surg 147:57–62

    Article  PubMed  Google Scholar 

  2. Kasotakis G, Lakha A, Sarkar B, Kunitake H, Kissane-Lee N, Dechert T, McAneny D, Burke P, Doherty G (2014) Trainee participation is associated with adverse outcomes in emergency general surgery: an analysis of the National Surgical Quality Improvement Program database. Ann Surg 260:483–490

    Article  PubMed  Google Scholar 

  3. Davis SS, Husain FA, Lin E, Nandipati KC, Perez S, Sweeney JF (2013) Resident participation in index laparoscopic general surgical cases: impact of the learning environment on surgical outcomes. J Am Coll Surg 216:96–104

    Article  PubMed  Google Scholar 

  4. Sakran JV, Hoffman RL, Ko C, Kelz RR (2013) The ACS NSQIP quality in-training initiative: educating residents to ensure the future of optimal surgical care. Bull Am Coll Surg 98:30–35

    PubMed  Google Scholar 

  5. Relles DM, Burkhart RA, Pucci MJ, Sendecki J, Tholey R, Drueding R, Sauter PK, Kennedy EP, Winter JM, Lavu H, Yeo CJ (2014) Does resident experience affect outcomes in complex abdominal surgery? Pancreaticoduodenectomy as an example. J Gastrointest Surg 18:279–285

    Article  PubMed  Google Scholar 

  6. Hernández-Irizarry R, Zendejas B, Ali SM, Lohse CM, Farley DR (2012) Impact of resident participation on laparoscopic inguinal hernia repairs: are residents slowing us down? J Surg Educ 69:746–752. doi:10.1016/j.jsurg.2012.08.013

    Article  PubMed  Google Scholar 

  7. de Santibañes M, Alvarez FA, Sieling E, Vaccarezza H, de Santibañes E, Vaccaro CA (2015) Postoperative complications at a university hospital: is there a difference between patients operated by supervised residents vs. trained surgeons? Langenbeck’s Arch Surg 400:77–82. doi:10.1007/s00423-014-1261-z

    Article  Google Scholar 

  8. Schreckenbach T, El Yourouri H, Bechstein EO, Habbe N (2015) Proctologic surgery done by residents—complications pre-programmed? J Visc Surg. doi:10.1016/j.jviscsurg.2015.11.013

    Google Scholar 

  9. (Muster) Weiterbildungsordung der Bundesärztekammer von 2003 mit den Erweiterungen und Ergänzungen 2013 [(Model) Specialty Training Regulations 2003 as amended on 28/06/2013]; (Model) Specialty Training Regulations 2003 as amended on 28/06/2013. http://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/MWBO_Englisch_210113_FINFI_aktualisiert171214.pdf. Accessed 12 Jan 2016

  10. The American Board of Surgery; Training and Certification http://www.absurgery.org/xfer/curriculumoutline2014-15.pdf. Accessed 12 Jan 2016

  11. Buerba R, Roman SA, Sosa JA (2011) Thyroidectomy and parathyroidectomy in patients with high body mass index are safe overall: analysis of 26,864 patients. Surgery 150:950–958. doi:10.1016/j.surg.2011.02.017

    Article  PubMed  Google Scholar 

  12. Ejaz A, Spolverato G, Kim Y, Wolfgang CL, Hirose K, Weiss M, Makary MA, Pawlik TM (2015) The impact of resident involvement on surgical outcomes among patients undergoing hepatic and pancreatic resections. Surgery 158:323–330. doi:10.1016/j.surg.2015.01.027

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hayward NJ, Grodski S, Yeung M, Johnson WR, Serpell J (2013) Recurrent laryngeal nerve injury in thyroid surgery: a review. ANZ J Surg 83:15–21. doi:10.1111/j.1445-2197.2012.06247.x

    Article  PubMed  Google Scholar 

  14. Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, Grond S, Mühlig HP, Richter C, Voss J, Thomusch O, Lippert H, Gastinger I, Brauckhoff M, Gimm O (2004) Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 136:1310–1322

    Article  PubMed  Google Scholar 

  15. Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I, Dralle H (2000) Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 24:1335–1341

    Article  CAS  PubMed  Google Scholar 

  16. Shaha A, Jaffe BM (1988) Complications of thyroid surgery performed by residents. Surgery 104:1109–1114

    CAS  PubMed  Google Scholar 

  17. Cheng H, Soleas I, Ferko NC, Clymer JW, Amaral JF (2015) A systematic review and meta-analysis of harmonic focus in thyroidectomy compared to conventional techniques. Thyroid Res 8:15. doi:10.1186/s13044-015-0027-1

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ross SW, Oommen B, Kim M, Walters AL, Green JM, Heniford BT, Augenstein VA (2014) A little slower, but just as good: postgraduate year resident versus attending outcomes in laparoscopic ventral hernia repair. Surg Endosc 28:3092–3100. doi:10.1007/s00464-014-3586-7

    Article  PubMed  Google Scholar 

  19. Fanous M, Carlin A (2012) Surgical resident participation in laparoscopic Roux-en-Y bypass: is it safe? Surgery 152:21–25. doi:10.1016/j.surg.2012.02.014

    Article  PubMed  Google Scholar 

  20. Uecker J, Luftman K, Ali S, Brown C (2013) Comparable operative times with and without surgery resident participation. J Surg Educ 70:696–699. doi:10.1016/j.jsurg.2013.06.011

    Article  PubMed  Google Scholar 

  21. Zendejas B, Cook DA, Bingener J, Huebner M, Dunn WF, Sarr MG, Farley DR (2011) Simulation-based mastery learning improves patient outcomes in laparoscopic inguinal hernia repair: a randomized controlled trial. Ann Surg 254:502–509. doi:10.1097/SLA.0b013e31822c6994

    Article  PubMed  Google Scholar 

  22. Jolley J, Lomelin D, Simorov A, Tadaki C, Oleynikov D (2015) Resident involvement in laparoscopic procedures does not worsen clinical outcomes but may increase operative times and length of hospital stay. Surg Endosc

Download references

Authors’ contributions

Study conception and design: Alexander Reinisch and Nils Habbe

Acquisition of data: Alexander Reinisch, Patrizia Malkomes and Katharina Holzer

Analysis and interpretation of data: Alexander Reinisch, Juliane Liese and Nils Habbe

Drafting of manuscript: Alexander Reinisch

Critical revision of manuscript: Nils Habbe, Juliane Liese, Wolf Otto Bechstein, Teresa Schreckenbach and Juliane Liese

Author information

Authors and Affiliations

  1. Department of General and Visceral Surgery, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany

    Alexander Reinisch, Patrizia Malkomes, Juliane Liese, Teresa Schreckenbach, Katharina Holzer, Wolf Otto Bechstein & Nils Habbe

Authors
  1. Alexander Reinisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrizia Malkomes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Juliane Liese
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Teresa Schreckenbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Katharina Holzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wolf Otto Bechstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nils Habbe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander Reinisch.

Ethics declarations

This study was not funded.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the local ethical committee of Frankfurt University (IRB No. 236/14).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Reinisch, A., Malkomes, P., Liese, J. et al. Education in thyroid surgery: a matched-pair analysis comparing residents and board-certified surgeons. Langenbecks Arch Surg 401, 239–247 (2016). https://doi.org/10.1007/s00423-016-1390-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-016-1390-7

Keywords

Search

Navigation