Guidelines for complications after thyroid surgery: pitfalls in diagnosis and advices for continuous quality improvement

Bures, Claudia; Klatte, Tobias; Friedrich, Gerhard; Kober, F.; Hermann, Michael

doi:10.1007/s10353-013-0247-3

Cited by 14 publications

(10 citation statements)

References 56 publications

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“…The analysis of the postoperative serum levels of PTH and calcium were routinely performed after every thyroid surgery on the first postoperative day. As part of the quality assurance, all patients with complications (i. e., hypoparathyroidism, recurrent laryngeal nerve palsy) were given appointments for routinely performed follow-up examinations in our clinic [ 4 , 13 ]. These routine appointments gave us the opportunity to undertake clinical and laboratory follow-up examinations at the institution and they take place 2 weeks, 3 months, and 6 months after surgery and every 6 months thereafter.…”

Section: Methodsmentioning

confidence: 99%

How many parathyroid glands can be identified during thyroidectomy?

et al. 2017

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SummaryBackgroundThe purpose of this study is to provide guidance for medical experts regarding malpractice claims on permanent hypoparathyroidism by analyzing the number of parathyroid glands (PGs) identified during thyroidectomy and the clinical outcome.MethodsParathyroid findings were documented in a standardized protocol for 357 patients undergoing thyroidectomy and treated by a single specialized surgeon. The resected thyroid was routinely dissected for accidentally removed PGs with consecutive autotransplantation and the pathological report also described unintentionally resected PGs. Follow-up was performed for 6 months.ResultsThe mean number of identified PGs was 2.28. No PGs were found in 20 (5.6%), one in 56 (15.7%), two in 126 (35.3%), three in 114 (31.9%), and four in 41 (11.5%) cases. One patient (0.28%) had manifest permanent hypoparathyroidism, while ten patients (2.8%) had latent permanent hypoparathyroidism (hypocalcemia and normoparathyroidism). The risk factors identified for postoperative hypoparathyroidism were an increasing number of visualized PGs, autotransplantation, central neck dissection, and PGs in the histopathological work-up. For permanent hypoparathyroidism, PGs in the histology examination and neck dissection were significant, but the number of identified PGs was not.ConclusionEven an experienced surgeon is not always able to find all four PGs during thyroidectomy and occasionally identifies none. Rather than focusing on identifying a minimum number of PGs, it is more important not to miss them in risky positions. A documented awareness of PGs, i. e., knowledge of variable parathyroid positions and their saving, is a prerequisite for surgical quality and to protect surgeons from claims.

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Section: Methodsmentioning

confidence: 99%

How many parathyroid glands can be identified during thyroidectomy?

et al. 2017

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“…All patients with normal postoperative vocal fold mobility were advised to return for a laryngoscopic examination in the event of a change in voice quality. Patients with vocal fold palsy were re‐examined after 2 weeks and every 2 months thereafter.…”

Section: Methodsmentioning

confidence: 99%

“…Preoperative and postoperative examination of vocal fold function by laryngoscopy is performed routinely at many centres and has been advised in guidelines. If vocal fold palsy is diagnosed, voice therapy is usually initiated with further laryngoscopic surveillance.…”

Section: Introductionmentioning

confidence: 99%

Late-onset palsy of the recurrent laryngeal nerve after thyroid surgery

Bures

Bobak-Wieser

Koppitsch

et al. 2014

British Journal of Surgery

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“…Nonetheless, multifocal PMCs need to be differentiated by their total tumor size, because the greater the aggregate tumor size, the more likely it is that a recurrent disease will occur. On the basis of consistent quality assurance, 36 it can be noted that radical surgical procedures and/or reoperations are associated with an increased risk of complications. 12,14,29,37 Radioiodine treatment.…”

Section: Article In Pressmentioning

confidence: 99%