title: Can a surgeon predict the risk of postoperative hypoparathyroidism during thyroid surgery? A prospective study on self-assessment by experts.
abstract: BACKGROUND
  Thyroid surgery can cause postoperative hypocalcemia (POH) and permanent hypoparathyroidism (PEH). Surgeons implicitly assess the risk and adapt their surgical strategy accordingly.
  
  
  METHODS
  The outcome of this intraoperative decision-making process (the surgeons' ability to predict the risk of POH and PEH on a numerical rating scale and their actual incidence) was studied prospectively in 2,558 consecutive thyroid operations.
  
  
  RESULTS
  POH and PEH occurred in 723 and 64 patients, respectively. In multivariate analysis, the surgeons' risk assessment score was an independent predictive factor for both complications (P < .05). Surgeons' differed significantly (P = .015) in their rates of POH but not of PEH (P = .062). Six and 3 (of 9) surgeons correctly predicted an increased risk of PEH and POH (adjusted odds ratios 1.67 to 2.21 and 1.47 to 12.73), respectively.
  
  
  CONCLUSIONS
  The risk for hypoparathyroidism can be estimated, but surgeons differ substantially in this ability and in the extent to which this implicit knowledge is translated into lower complication rates.
authors.affiliation: Second Department of Surgery "Kaiserin Elisabeth", Krankenanstalt Rudolfstiftung, Vienna, Austria; Department of Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Regina
authors.initials: R
authors.lastname: Promberger
authors.affiliation: Second Department of Surgery "Kaiserin Elisabeth", Krankenanstalt Rudolfstiftung, Vienna, Austria; Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria. Electronic address: johannes.ott@meduniwien.ac.at.
authors.forename: Johannes
authors.initials: J
authors.lastname: Ott
authors.affiliation: Second Department of Surgery "Kaiserin Elisabeth", Krankenanstalt Rudolfstiftung, Vienna, Austria.
authors.forename: Claudia
authors.initials: C
authors.lastname: Bures
authors.affiliation: Second Department of Surgery "Kaiserin Elisabeth", Krankenanstalt Rudolfstiftung, Vienna, Austria.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Kober
authors.affiliation: Department of Craniomaxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Freissmuth
authors.affiliation: Second Department of Surgery "Kaiserin Elisabeth", Krankenanstalt Rudolfstiftung, Vienna, Austria; Institute of Pharmacology, Centre for Biomolecular Medicine and Pharmacology, Medical University of Vienna, Vienna, Austria.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Seemann
authors.affiliation: Second Department of Surgery "Kaiserin Elisabeth", Krankenanstalt Rudolfstiftung, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Hermann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D007011:Hypoparathyroidism / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D007432:Intraoperative Period; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000175:diagnosis* / Q000517:prevention & control; D011379:Prognosis; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012647:Self-Assessment; D013965:Thyroidectomy; D055815:Young Adult
keywords: Hypocalcemia; Hypoparathyrodism; Individual surgeon; Quality control; Risk assessment; Thyroid surgery