Analysis of Variations in the Use of Intraoperative Nerve Monitoring in Thyroid Surgery

Al‐Qurayshi, Zaid; Randolph, Gregory W.; Alshehri, Mohammed; Kandil, Emad

doi:10.1001/jamaoto.2016.0412

Cited by 31 publications

(32 citation statements)

References 29 publications

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“…Intraoperative nerve monitoring (IONM) was introduced to assist with identification of the RLN during thyroidectomy . IONM is used more frequently in the United States during thyroidectomy, and it has been reported that IONM is used during approximately 80% of thyroid surgeries performed by head and neck surgeons and >50% of surgeries performed by general surgeons . However, its utility for reducing RLNP remains controversial.…”

Section: Introductionmentioning

confidence: 99%

“…6 IONM is used more frequently in the United States during thyroidectomy, and it has been reported that IONM is used during approximately 80% of thyroid surgeries performed by head and neck surgeons and >50% of surgeries performed by general surgeons. 7 However, its utility for reducing RLNP remains controversial. Several studies, including observational studies, metaanalyses, and a randomized controlled study, have demonstrated a slight reduction in RLNP incidence when IONM is used, but most have failed to establish statistical significance when comparing IONM with direct visualization alone.…”

Section: Introductionmentioning

confidence: 99%

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Recurrent laryngeal nerve paralysis after thyroid cancer surgery and intraoperative nerve monitoring

et al. 2018

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Objectives/Hypothesis This study aimed to investigate the risk of postoperative recurrent laryngeal nerve paralysis (RLNP) with and without the use of intraoperative nerve monitoring (IONM) during thyroid cancer surgery. Study Design Retrospective cohort study. Methods This study utilized a nationwide claims database in Japan. Patients who underwent thyroid cancer surgery with and without IONM were included, and postoperative RLNP incidence was compared. Results The study included 5,804 patients. Multivariable logistic regression analysis revealed that use of IONM was not associated with increased RLNP risk (odds ratio: 1.15; 95% confidence interval: 0.67‐1.96). There was no significant effect on RLNP prevention when stratified by tumor or nodal classification. Rather, the patients who had T4 or N1b classifications who received IONM had higher incidences of RLNP. Conclusions Use of IONM did not significantly reduce the risk of RLNP. The results for the T4 and N1b populations may be explained by indication bias or unmeasured confounders. Level of Evidence NALaryngoscope, 129:1954–1960, 2019

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Recurrent laryngeal nerve paralysis after thyroid cancer surgery and intraoperative nerve monitoring

et al. 2018

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“…In addition, the IONM utilization pattern was independently affected by surgeon and hospital volumes, regardless of patients' clinical presentation 36 . These data may reflect physicians' practice beliefs or administrative factors influencing IONM use 37 , but could also represent economic barriers associated with IONM, which the present study was designed to elucidate 37 .…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of intraoperative nerve monitoring in avoidance of bilateral recurrent laryngeal nerve injury in patients undergoing total thyroidectomy

Al‐Qurayshi

Kandil

Randolph

2017

British Journal of Surgery

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“…The use of IONM has gained popularity in the last decade amongst surgeons with up to 80% of otolaryngologists in Australia using IONM . Increases in the usage of IONM have been reported worldwide with rates up to 90% in Germany, 80% in the USA, and 50% in the rest of Europe . Whilst direct visualization of the recurrent laryngeal nerve (RLN) remains the gold standard, there is evidence that the routine use of IONM may reduce temporary, bilateral and permanent RLN palsy rates .…”

Section: Introductionmentioning

confidence: 99%

Intraoperative nerve monitoring in endocrine surgery: prevalence and reasons for its use in Australia and New Zealand

Leong

Ryan

et al. 2019

ANZ Journal of Surgery

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Background: Intraoperative nerve monitoring (IONM) has increasingly been used in thyroid surgery by general, endocrine and head and neck surgeons. The purpose of this paper was to explore the prevalence and reasons for the usage of IONM in endocrine surgery in Australia and New Zealand. Methods: A survey was sent to general surgeons registered with the Royal Australasian College of Surgeons involved in endocrine surgery and members of the Australian and New Zealand Endocrine Surgeons. Users were divided into surgeon type, area of work, hospital type and volume of surgery. These data were analysed with univariate and multivariate logistic regression models. Results: Significant differences in IONM usage levels were observed between endocrine and general surgeons, area of work and volume of surgery performed. Endocrine surgeons are significantly more likely to use IONM than general surgeons. Surgeons who work in tertiary hospitals are more likely to use IONM as compared to those working in district hospitals. Surgeons who perform less than 100 thyroidectomies were more likely to be users of IONM. Conclusion: IONM is not routinely used in thyroid surgery in Australia and New Zealand. The main reasons for the use of IONM given in our study by routine users were to establish familiarity of equipment and medicolegal reasons. Selective users chose as the most common reasons, a documented pre-existing unilateral nerve paresis or a hostile surgical field. Non-users stated that there was conflicting evidence that it improves outcomes and increased costs. © 2019 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 867-871ANZJSurg.com

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Analysis of Variations in the Use of Intraoperative Nerve Monitoring in Thyroid Surgery

Abstract: Disparities in the use of IONM are based on demographic factors of the patients and surgeon volume. Intraoperative nerve monitoring appears to be used less in black patients or those with Medicare health coverage and is not associated with the risk for vocal cord paralysis.

Cited by 31 publications

References 29 publications

Recurrent laryngeal nerve paralysis after thyroid cancer surgery and intraoperative nerve monitoring

Recurrent laryngeal nerve paralysis after thyroid cancer surgery and intraoperative nerve monitoring

Cost-effectiveness of intraoperative nerve monitoring in avoidance of bilateral recurrent laryngeal nerve injury in patients undergoing total thyroidectomy

Intraoperative nerve monitoring in endocrine surgery: prevalence and reasons for its use in Australia and New Zealand

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