title: Can Total Thyroidectomy Be Safely Performed by Residents?: A Comparative Retrospective Multicenter Study.
abstract: This retrospective comparative multicenter study aims to analyze the impact on patient outcomes of total thyroidectomy (TT) performed by resident surgeons (RS) with close supervision and assistance of attending surgeons (AS).All patients who underwent TT between 2009 and 2013 in 10 Units of endocrine surgery (8 in Italy, 1 in France, and 1 in UK) were evaluated. Demographic data, preoperative diagnosis, extension of goiter, type of surgical access, surgical approach, operative time, use and duration of drain, length of hospitalization, histology, and postoperative complications were recorded. Patients were divided into 3 groups: A, when treated by an AS assisted by an RS; B and C, when treated by a junior and a senior RS, respectively, assisted by an AS.The 8908 patients (mean age 51.1 ± 13.6 years), with 6602 (74.1%) females were enrolled. Group A counted 7092 (79.6%) patients, Group B 261 (2.9%) and Group C 1555 (17.5%). Operative time was significantly greater (P < 0.001) in B (101.3 ± 43.0 min) vs A (71.8 ± 27.6 min) and C (81.2 ± 29.9 min). Duration of drain was significantly lower (P < 0.001) in A (47.4 ± 13.2 h) vs C (56.4 ± 16.5 h), and in B (42.8 ± 14.9 h) vs A and C. Length of hospitalization was significantly longer (P < 0.001) in C (3.8 ± 1.8 days) vs B (2.4 ± 1.0 days) and A (2.6 ± 1.5 days). No mortality occurred. Overall postoperative morbidity was 22.3%: it was significantly higher in B vs A (29.5% vs 22.3%; odds ratio [OR] 1.46, 95% confidence interval [CI] 1.11-1.92, P = 0.006) and C (21.3%; OR 1.55, 95% CI 1.15-2.07, P = 0.003). No differences were found for recurrent laryngeal nerve palsy, hypoparathyroidism, hemorrhage, and wound infection. The adjusted ORs in multivariate analysis showed that overall morbidity remained significantly associated with Group B vs A (OR 1.48, 95% CI 1.12-1.96, P = 0.005) and vs C (OR 1.60, 95% CI 1.19-2.17, P = 0.002), while no difference was observed in Group A vs B + C.TT can be safely performed by residents correctly supervised. Innovative gradual training in dedicated high-volume hospitals should be proposed in order to allow adequate autonomy for the RS and safeguard patient outcome.
authors.affiliation: From the Department of Biomedical Sciences and Human Oncology (AG, GDM, AP, MT), University Medical School of Bari, Bari; Department of Surgery (RB, CPL, MR), University Medical School "Cattolica del Sacro Cuore," Rome; Department of Medical and Surgical Sciences and Biotechnologies (GC), University Medical School "La Sapienza," Rome; Department of Surgery (MC, MI), Oncology and Gastroenterology, University of Padova, Padova; Department of Anesthesiology (GC, GD, ST), Surgical and Emergency Sciences, Second University of Naples, Naples; Department of Surgical (GM, PM), Medical, Molecular Pathology, Critical Area, University Medical School of Pisa, Pisa; Department of Surgical Sciences (MM), University Medical School of Genoa, Genoa, Italy; Department of Thyroid and Endocrine Surgery (VC, FP), Imperial College London, London, UK; and Department of General and Endocrine Surgery (IFF, FS), Hôpital de la Timone, Marseille, France.
authors.forename: Angela
authors.initials: A
authors.lastname: Gurrado
authors.forename: Rocco
authors.initials: R
authors.lastname: Bellantone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cavallaro
authors.forename: Marilisa
authors.initials: M
authors.lastname: Citton
authors.forename: Vasilis
authors.initials: V
authors.lastname: Constantinides
authors.forename: Giovanni
authors.initials: G
authors.lastname: Conzo
authors.forename: Giovanna
authors.initials: G
authors.lastname: Di Meo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Docimo
authors.forename: Ilaria Fabiola
authors.initials: IF
authors.lastname: Franco
authors.forename: Maurizio
authors.initials: M
authors.lastname: Iacobone
authors.forename: Celestino Pio
authors.initials: CP
authors.lastname: Lombardi
authors.forename: Gabriele
authors.initials: G
authors.lastname: Materazzi
authors.forename: Michele
authors.initials: M
authors.lastname: Minuto
authors.forename: Fausto
authors.initials: F
authors.lastname: Palazzo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pasculli
authors.forename: Marco
authors.initials: M
authors.lastname: Raffaelli
authors.forename: Frederic
authors.initials: F
authors.lastname: Sebag
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tolone
authors.forename: Paolo
authors.initials: P
authors.lastname: Miccoli
authors.forename: Mario
authors.initials: M
authors.lastname: Testini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013965:Thyroidectomy / Q000009:adverse effects / Q000193:education*; D016896:Treatment Outcome; D055815:Young Adult