Trainee participation does not adversely affect the safety of thyroid surgery: Systematic review and meta-analysis.
evidence-based medicine
meta-analysis
surgical complications
surgical education
thyroidectomy
Journal
Head & neck
ISSN: 1097-0347
Titre abrégé: Head Neck
Pays: United States
ID NLM: 8902541
Informations de publication
Date de publication:
01 2022
01 2022
Historique:
revised:
13
09
2021
received:
29
07
2021
accepted:
07
10
2021
pubmed:
29
10
2021
medline:
27
1
2022
entrez:
28
10
2021
Statut:
ppublish
Résumé
Surgical traineeship is essential but must be safe for patients. In thyroid surgery, surgeon volume correlates with improved clinical/economic outcomes. However, it is presently unclear how far does trainee participation affect post-thyroidectomy complication rates in real-world and randomized data. We systematically searched four databases for associations of trainee participation with any post-thyroidectomy outcome. We conducted univariate meta-analyses, sensitivity analyses, and assessed publication bias qualitatively and quantitatively. We included 1 randomized and 15 observational studies from 3755 records, comprising 34 774 thyroid surgical patients. Trainee participation was associated with 12 min longer operative time, but not higher complication rates (hypoparathyroidism, recurrent laryngeal nerve palsy, hematoma, blood loss, return to operating room, hospitalization duration, readmission, and mortality). Sensitivity, publication bias, and multivariate analyses did not change our findings. Real-world and limited randomized data suggest that trainee participation in thyroid surgery is safe, given adequate consultant supervision and appropriate case selection.
Types de publication
Journal Article
Meta-Analysis
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
262-274Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Nouraei SA, Virk JS, Middleton SE, et al. A national analysis of trends, outcomes and volume-outcome relationships in thyroid surgery. Clin Otolaryngol. 2017;42(2):354-365.
Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg. 1998;228(3):320-330.
Lee LC, Reines HD, Domanski M, Zapanta P, Robinson L. General surgery and otolaryngology resident perspectives on obtaining competency in thyroid surgery. J Surg Educ. 2012;69(5):593-598.
Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349(22):2117-2127.
Casson AG, van Lanschot JJ. Improving outcomes after esophagectomy: the impact of operative volume. J Surg Oncol. 2005;92(3):262-266.
Courcoulas A, Schuchert M, Gatti G, Luketich J. The relationship of surgeon and hospital volume to outcome after gastric bypass surgery in Pennsylvania: a 3-year summary. Surgery. 2003;134(4):613-621. discussion 621-613.
Ambe PC, Wassenberg DR. Is sutureless thyroid surgery safe in the hands of surgical trainees. A single centre retrospective study. BMC Res Notes. 2016;9:118.
Feeney T, Price LL, Chen L, Graham R, Chatterjee A. Resident and fellow participation in thyroid and parathyroid surgery: an ACS-NSQIP clinical outcomes analysis. J Surg Res. 2017;220:346-352.
Hassan I, Koller M, Kluge C, Hoffmann S, Zielke A, Rothmund M. Supervised surgical trainees perform thyroid surgery for Graves' disease safely. Langenbecks Arch Surg. 2006;391(6):597-602.
Mishra A, Agarwal G, Agarwal A, Mishra SK. Safety and efficacy of total thyroidectomy in hands of endocrine surgery trainees. Am J Surg. 1999;178(5):377-380.
Duclos A, Peix JL, Colin C, et al. Influence of experience on performance of individual surgeons in thyroid surgery: prospective cross sectional multicentre study. BMJ. 2012;344:d8041.
Choudhry NK, Fletcher RH, Soumerai SB. Systematic review: the relationship between clinical experience and quality of health care. Ann Intern Med. 2005;142(4):260-273.
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283(15):2008-2012.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210.
Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2012; http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed April 24, 2019.
Cochrane Collaboration. Section 13.5.2.3. Tools for assessing methodological quality or risk of bias in non-randomized studies. In: Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0; Chichester, UK: John Wiley & Sons; 2011.
Kojima G, Avgerinou C, Iliffe S, Walters K. Adherence to Mediterranean diet reduces incident frailty risk: systematic review and meta-analysis. J Am Geriatr Soc. 2018;66(4):783-788.
Saraiva MD, Suzuki GS, Lin SM, de Andrade DC, Jacob-Filho W, Suemoto CK. Persistent pain is a risk factor for frailty: a systematic review and meta-analysis from prospective longitudinal studies. Age Ageing. 2018;47(6):785-793.
Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ (Clinical Research Ed). 2011;343:d5928.
Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22(4):719-748.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539-1558.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical Research Ed). 1997;315(7109):629-634.
Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56(2):455-463.
Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924-926.
Acun Z, Cihan A, Ulukent SC, et al. A randomized prospective study of complications between general surgery residents and attending surgeons in near-total thyroidectomies. Surg Today. 2004;34(12):997-1001.
Akyildiz S, Ogut F, Akyildiz M, Engin EZ. A multivariate analysis of objective voice changes after thyroidectomy without laryngeal nerve injury. Arch Otolaryngol Head Neck Surg. 2008;134(6):596-602.
Burge MR, Zeise TM, Johnsen MW, Conway MJ, Qualls CR. Risks of complication following thyroidectomy. J Gen Intern Med. 1998;13(1):24-31.
Emre AU, Cakmak GK, Tascilar O, et al. Complications of total thyroidectomy performed by surgical residents versus specialist surgeons. Surg Today. 2008;38(10):879-885.
Erbil Y, Barbaros U, Işsever H, et al. Predictive factors for recurrent laryngeal nerve palsy and hypoparathyroidism after thyroid surgery. Clin Otolaryngol. 2007;32(1):32-37.
Folsom C, Serbousek K, Lydiatt W, et al. Impact of resident training on operative time and safety in hemithyroidectomy. Head Neck. 2017;39(6):1212-1217.
Gurrado A, Bellantone R, Cavallaro G, et al. Can total thyroidectomy be safely performed by residents?: a comparative retrospective multicenter study. Medicine (Baltimore). 2016;95(14):e3241.
Kshirsagar RS, Chandy Z, Mahboubi H, Verma SP. Does resident involvement in thyroid surgery lead to increased postoperative complications? Laryngoscope. 2017;127(5):1242-1246.
Lamadé W, Renz K, Willeke F, Klar E, Herfarth C. Effect of training on the incidence of nerve damage in thyroid surgery. Br J Surg. 1999;86(3):388-391.
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. 2016;401(2):239-247.
Runkel N, Riede E, Mann B, Buhr HJ. Surgical training and vocal-cord paralysis in benign thyroid disease. Langenbecks Arch Surg. 1998;383(3-4):240-242.
Tongol M, Mirasol R. Incidence and risk factors for post-thyroidectomy hypocalcemia. J ASEAN Fed Endocr Soc. 2016;31(1):30-36.
Macaskill P, Walter SD, Irwig L. A comparison of methods to detect publication bias in meta-analysis. Stat Med. 2001;20(4):641-654.
Liang TJ, Liu SI, Mok KT, Shi HY. Associations of volume and thyroidectomy outcomes: a Nationwide study with systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2016;155(1):65-75.
Anderson BR, Wallace AS, Hill KD, et al. Association of surgeon age and experience with congenital heart surgery outcomes. Circ Cardiovasc Qual Outcomes. 2017;10(7):e003533.
Grąt M, Lewandowski Z, Patkowski W, et al. Individual surgeon experience yields bimodal effects on patient outcomes after deceased-donor liver transplant: results of a quantile regression for survival data. Exp Clin Transplant. 2018;16(4):425-433.