Can a surgeon predict the risk of postoperative hypoparathyroidism during thyroid surgery? A prospective study on self-assessment by experts

Promberger, Regina; Ott, Johannes; Bures, Claudia; Kober, F.; Freissmuth, Michael; Seemann, Rudolf; Hermann, Michael

doi:10.1016/j.amjsurg.2013.11.007

Cited by 18 publications

(15 citation statements)

References 16 publications

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“…Studies support the predictive value of surgeon immediate post-operative risk assessments and frustration during surgery in predicting complications of thyroid, abdominal, and hernia surgeries 24,25,26 , although intraoperative surgeon opinion on the success of endoscopic repair of vesicoureteral reflux only poorly predicted cure 27 , but associations of surgeon factors with AVF thrombosis have not been well studied. In the United States, dialysis access surgery is performed by general, vascular, transplant, and cardiothoracic surgeons, who may or may not be board certified in their respective fields.…”

Section: Discussionmentioning

confidence: 99%

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Multiple preoperative and intraoperative factors predict early fistula thrombosis in the Hemodialysis Fistula Maturation Study

Larive

Feldman

et al. 2016

Journal of Vascular Surgery

106

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OBJECTIVES Early thrombosis (ET) contributes to autogenous arteriovenous fistula (AVF) failure. We studied patients undergoing AVF placement in the Hemodialysis Fistula Maturation (HFM) Study, a prospective, observational cohort study, using a nested case-control analysis to identify pre-operative and intra-operative predictors of ET. METHODS ET cases were compared to controls who were matched on gender, age, diabetes, dialysis status, and surgeon fistula volume. ET was defined as thrombosis diagnosed by physical exam or ultrasound within 18 days of AVF creation. Conditional logistic regression models were fit to identify risk factors for ET. RESULTS Thirty-two ET cases (5.3%) occurred among 602 study participants; 198 controls were matched. ET was associated with female gender (OR=2.75, CI 1.19–6.38, P=0.018), fistula location (forearm vs. upper arm) (OR=2.76, CI 1.05–7.23, P=0.039), feeding artery (radial vs. brachial) (OR=2.64, CI 1.03–6.77, P=0.043) and arterial diameter (OR=1.52, CI 1.02–2.26, P=0.039, per mm smaller). Draining vein diameter was nonlinearly associated with ET, with highest risk in 2–3 mm veins. Surprisingly, ET risk was lower in diabetics (OR=0.19, CI 0.07–0.47, P=0.0004), lower with less nitroglycerin-mediated brachial artery dilatation (NMD%) (OR=0.42, CI 0.20–1.92, P=0.029 for each 10% lower) and higher with lower carotid-femoral pulse wave velocity (OR=1.49, CI 1.02–2.20, P=0.041, for each m/sec lower). Intraoperative protamine use was associated with a higher ET risk (OR 3.26, CI 1.28-∞, P=0.038). Surgeon’s intraoperative perceptions were associated with ET: surgeons’ greater concern about maturation success (likely, marginal, unlikely) was associated with higher thrombosis risk (OR 8.09, CI 4.03-∞, p<0.0001, per category change), as were absence vs. presence of intraoperative thrill (OR 21.0, CI 5.07-∞, P=0.0002) and surgeons’ reported frustration during surgery (OR 6.85, CI 2.70-∞, P=0.0004). Reduced extent of intraoperative thrill (proximal, mid or distal third of the forearm or upper arm, based on AVF placement) was also associated with ET (OR 2.91, CI 1.31-∞, P=0.014, per diminished level). Oral antithrombotic medication use was not significantly associated with ET. CONCLUSIONS ET was found to be associated with female gender, forearm AVF, smaller arterial size, draining vein diameter of 2–3 mm, and protamine use. Paradoxically, diabetes and stiff, noncompliant feeding arteries were associated with lower frequency of ET. Absent or attenuated intraoperative thrill, and both surgeon frustration and concern about successful maturation during surgery, were strongly correlated with ET.

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Section: Discussionmentioning

confidence: 99%

“…Computations were performed using SAS 9.3 PROC LOGISTIC and other components, and the LGTPHCURV9 macro 24 for spline fitting. Unless otherwise noted, statistical significance was assessed using two-sided 5% level tests.…”

Section: Methodsmentioning

confidence: 99%

Multiple preoperative and intraoperative factors predict early fistula thrombosis in the Hemodialysis Fistula Maturation Study

Larive

Feldman

et al. 2016

Journal of Vascular Surgery

106

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“…Three studies 20,22,39 comprising 2832 patients (all risk assessments made after surgery) evaluated operationspecific morbidity prediction ( Table 2). Two 22,39 (274 patients) assessed surgeons' estimate of developing an anastomotic leak after primary anastomosis.…”

Section: Operation-specific Morbiditymentioning

confidence: 99%

Systematic review and narrative synthesis of surgeons' perception of postoperative outcomes and risk

et al. 2020

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Background: The accuracy with which surgeons can predict outcomes following surgery has not been explored in a systematic way. The aim of this review was to determine how accurately a surgeon's 'gut feeling' or perception of risk correlates with patient outcomes and available risk scoring systems.Methods: A systematic review was undertaken in accordance with PRISMA guidelines. A narrative synthesis was performed in accordance with the Guidance on the Conduct of Narrative Synthesis In Systematic Reviews. Studies comparing surgeons' preoperative or postoperative assessment of patient outcomes were included. Studies that made comparisons with risk scoring tools were also included. Outcomes evaluated were postoperative mortality, general and operation-specific morbidity and long-term outcomes.Results: Twenty-seven studies comprising 20 898 patients undergoing general, gastrointestinal, cardiothoracic, orthopaedic, vascular, urology, endocrine and neurosurgical operations were included. Surgeons consistently overpredicted mortality rates and were outperformed by existing risk scoring tools in six of seven studies comparing area under receiver operating characteristic (ROC) curves (AUC).Surgeons' prediction of general morbidity was good, and was equivalent to, or better than, pre-existing risk prediction models. Long-term outcomes were poorly predicted by surgeons, with AUC values ranging from 0⋅51 to 0⋅75. Four of five studies found postoperative risk estimates to be more accurate than those made before surgery.Conclusion: Surgeons consistently overestimate mortality risk and are outperformed by pre-existing tools; prediction of longer-term outcomes is also poor. Surgeons should consider the use of risk prediction tools when available to inform clinical decision-making.

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“…Although mechanical and VR constructs allow surgeons to acquire psychomotor and technical skills, they neglect an emphasis on important non-technical skills like cognitive decision-making. Decision-making contributes to demonstration of clinical and non-technical competency [8,9].…”

Section: Introductionmentioning

confidence: 99%

Validating Touch Surgery™: A cognitive task simulation and rehearsal app for intramedullary femoral nailing

Sugand

Mawkin

Gupte

2015

Injury

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Can a surgeon predict the risk of postoperative hypoparathyroidism during thyroid surgery? A prospective study on self-assessment by experts

Cited by 18 publications

References 16 publications

Multiple preoperative and intraoperative factors predict early fistula thrombosis in the Hemodialysis Fistula Maturation Study

Multiple preoperative and intraoperative factors predict early fistula thrombosis in the Hemodialysis Fistula Maturation Study

Systematic review and narrative synthesis of surgeons' perception of postoperative outcomes and risk

Validating Touch Surgery™: A cognitive task simulation and rehearsal app for intramedullary femoral nailing

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