A randomized prospective study of complications between general surgery residents and attending surgeons in near-total thyroidectomies.
OBJECTIVE
Recurrent laryngeal nerve palsy and hypoparathyroidism are the most common and serious complications after thyroid operations. Surgeon experience has been defined as a significant factor in the number of complications occurring in thyroid surgery. There has so far been no prospective randomized study that compares the complication rates between residents and the attending surgeon in statistically similar patient groups in which all of the patients undergo the same type of thyroid surgery by the same surgical team. In this prospective study the performances of residents and attending surgeons were evaluated and compared according to the complication rates in near-total thyroidectomies.


METHODS
One hundred and fifty-two patients underwent near-total thyroidectomies between April 2001 and May 2003. The number of randomly selected patients operated on by residents at the level of postgraduate year two, under the direct supervision of an attending surgeon, and the number of patients operated on by attending surgeons were 78 and 74, respectively. All patients had preoperative and postoperative videolaryngostroboscopic examinations of the vocal cords and serum calcium level evaluation.


RESULTS
The rates of temporary vocal cord paralysis with respect to the nerves at risk for residents and attending surgeons were 3.7% and 2.7%, respectively. The temporary hypoparathyroidism rate was 8.1% for attending surgeons, whereas it was found to be 6.4% for residents. Neither any cases of permanent vocal cord paralysis nor permanent hypoparathyroidism were detected.


CONCLUSIONS
Our results indicate that the complication rates in near-total thyroidectomies performed by residents and attending surgeons are similar. Thyroid surgery can therefore be safely and effectively performed by residents under close supervision.
Acun
Zeki
Z
General Surgery Department, Zonguldak Karaelmas University, School of Medicine, 67600 Kozlu, Zonguldak, Turkey.
Cihan
Alper
A
Ulukent
Suat Can
SC
Comert
Mustafa
M
Ucan
Bulent
B
Cakmak
Guldeniz Karadeniz
GK
Cesur
Ali
A
D000328:Adult; D002983:Clinical Competence; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D010818:Practice Patterns, Physicians'; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D013959:Thyroid Diseases / Q000175:diagnosis / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome