Universal Use of Intraoperative Nerve Monitoring by Recently Fellowship-Trained Thyroid Surgeons is Common, Associated with Higher Surgical Volume, and Impacts Intraoperative Decision-Making.
BACKGROUND
The value of routine use of intraoperative recurrent laryngeal nerve monitoring (IONM) in thyroid surgery is controversial. We analyzed the practices of recently fellowship-trained thyroid surgeons from two diverging surgical backgrounds with respect to IONM. We hypothesized that the majority of recently trained surgeons would use IONM, and that it would potentially influence their operative procedure.


METHODS
A 21-question survey was sent to 56 fellowship-trained endocrine and head and neck surgeons who completed fellowships accredited by the American Association of Endocrine Surgeons or American Head and Neck Society within the past 10 years, examining the demographics of respondents, and details of IONM practice. Groups were compared using the Fisher exact and χ (2) tests.


RESULTS
The response rate for the survey was 76 % (42/56). Overall, 95 % use IONM for some or all of their cases. Sixty percent (n = 25) of respondents always use IONM during thyroid surgery, 36 % (n = 15) use it selectively, and 5 % (n = 2) never use it. We compared respondents who always use IONM (n = 25), to those who selectively or never use it (n = 17). Exposure to IONM during residency or fellowship did not influence use (p = 0.99). However, higher-volume surgeons were more likely to always use IONM (p = 0.036). Among users of IONM, the most common reason given for use was increased surgeon confidence (55 %) and improved safety (54 %). Over 90 % of respondents found reoperative cases and preoperative vocal cord paralysis to be indications for IONM. Among those who always used IONM, 64 % would alter extent of surgery based on IONM findings, compared to only 27 % of selective users.


CONCLUSIONS
A survey of recently trained endocrine and head and neck surgeons reveals that the vast majority (95 %) of these surgeons commonly use IONM during thyroid surgery. IONM was more commonly used by higher-volume surgeons. Routine users were more likely to modify surgery based on nerve integrity (i.e., not complete a total thyroidectomy if the nerve loses conduction signal).
Division of Endocrine Surgery, Department of Surgery, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 4E11, New York, NY, 10003, USA. jmarti@chpnet.org.
Jennifer L
JL
Marti
Endocrine Surgical Service, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, WACC 460, Boston, MA, 02115, USA.
Tammy
T
Holm
Endocrine Surgical Service, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, WACC 460, Boston, MA, 02115, USA.|Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles ST, Boston, MA, 02115, USA.
Gregory
G
Randolph
D000328:Adult; D003657:Decision Making; D005257:Fellowships and Scholarships / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006257:Head / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000706:statistics & numerical data*; D009333:Neck / Q000601:surgery; D061214:Patient Safety; D010818:Practice Patterns, Physicians'; D012009:Recurrent Laryngeal Nerve / Q000502:physiology; D061226:Recurrent Laryngeal Nerve Injuries / Q000517:prevention & control; D012086:Reoperation; D020377:Self Efficacy; D066231:Surgeons / Q000193:education / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013961:Thyroid Gland / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods / Q000706:statistics & numerical data*; D014826:Vocal Cord Paralysis / Q000175:diagnosis