title: Education in thyroid surgery: a matched-pair analysis comparing residents and board-certified surgeons.
abstract: OBJECTIVE
  Resident participation in operative procedures is mandatory in educational residency programs but remains controversial, especially in the context of patient safety. This study compared the surgical quality and outcomes of thyroidectomies performed by surgical residents (RESs) and board-certified surgeons (BCSs).
  
  
  METHODS
  This retrospective matched-pair study included patients undergoing thyroidectomies for multinodular goiter, Grave's disease and early-stage thyroid cancer that were performed by a RES with BCS supervision between 2006 and 2014. The intraoperative and postoperative course, complication rates and handling of the recurrent laryngeal nerve (RLN) and parathyroid glands were analyzed.
  
  
  RESULTS
  In total, 112 thyroidectomies that were performed by a RES fulfilled the inclusion criteria and were matched 1:1 with BCS patients. We included 88 hemithyroidectomies, 80 subtotal thyroidectomies and 56 total thyroidectomies. No significant differences in the handling of the RLN or parathyroid glands, the rates of postoperative RLN palsies or the rates of hypocalcaemia were found. No intraoperative complications led to the replacement of the RES as the surgeon-in-charge. Three RES and two BCS patients experienced postoperative haemorrhages (p = 0.205), and three surgical site infections (p = 1.000) occurred in each group. The mean operative time and the length of stay did not differ significantly between the two groups.
  
  
  CONCLUSIONS
  Major aspects of patient safety in thyroid surgery are not affected by resident participation. Thyroidectomies performed by RES are not significantly longer and reveal no differences in length of stay or complication rates. The economic burden of resident involvement is modest.
authors.affiliation: Department of General and Visceral Surgery, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany. alexander.reinisch@kgu.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Reinisch
authors.affiliation: Department of General and Visceral Surgery, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Malkomes
authors.affiliation: Department of General and Visceral Surgery, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Juliane
authors.initials: J
authors.lastname: Liese
authors.affiliation: Department of General and Visceral Surgery, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Teresa
authors.initials: T
authors.lastname: Schreckenbach
authors.affiliation: Department of General and Visceral Surgery, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Holzer
authors.affiliation: Department of General and Visceral Surgery, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Wolf Otto
authors.initials: WO
authors.lastname: Bechstein
authors.affiliation: Department of General and Visceral Surgery, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Habbe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013043:Specialties, Surgical; D013959:Thyroid Diseases / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000193:education*; D055815:Young Adult
keywords: Patient safety; Resident involvement; Resident participation; Surgical education; Thyroid