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

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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.

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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

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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
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  2. Patrizia Malkomes
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  3. Juliane Liese
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  4. Teresa Schreckenbach
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  5. Katharina Holzer
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  6. Wolf Otto Bechstein
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  7. Nils Habbe
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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).

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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

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

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