Revista de calidad asistencial : organo de la Sociedad Espanola de Calidad Asistencial · 2013
[Hemostasis and neuromonitoring as patient safety measures in thyroid surgery].
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Pardal-Refoyo J L
Аннотация
INTRODUCTION: The most frequent adverse effects after thyroidectomy are hemorrhage, recurrent laryngeal nerve (RLN) palsy, hypoparathyroidism, and airway complications.
OBJECTIVES: To evaluate if improvement actions introduced in thyroidectomy have an influence on monitored sentinel events after surgery of thyroid gland.
METHOD: A retrospective study of 954 patients subjected to thyroidectomy during the period 1997 to 2011. The hemostasis techniques used were, conventional ligature and mono or bipolar electrocoagulation in period A (1997-2006), and the Harmonic Ultracision(®) technology was used exclusively during periods B (2006-2010) and C (2011). The identification the RLN was performed visually in periods A-B and by intraoperative neuromonitoring in period C.
RESULTS: On comparing periods A and B + C, there was a significant reduction in the incidence of bleeding from 1.92% to 0.24% (P=.007), and postoperative complications in the airway that required tracheotomy from 1.28% to 0% (P=.012). The reductions in the incidence of RLN paralysis (from 1.32% to 0.8%, P=.45) and hypoparathyroidism (from 1.1% to 0.6%, P=.42) were not statistically significant. The number of annual events decreased from period A (odds ratio=3.51) to C (odds ratio=0.39).
CONCLUSIONS: Technical improvements in hemostasis, and identification of RLN, increase patient safety in thyroid surgery.
OBJECTIVES: To evaluate if improvement actions introduced in thyroidectomy have an influence on monitored sentinel events after surgery of thyroid gland.
METHOD: A retrospective study of 954 patients subjected to thyroidectomy during the period 1997 to 2011. The hemostasis techniques used were, conventional ligature and mono or bipolar electrocoagulation in period A (1997-2006), and the Harmonic Ultracision(®) technology was used exclusively during periods B (2006-2010) and C (2011). The identification the RLN was performed visually in periods A-B and by intraoperative neuromonitoring in period C.
RESULTS: On comparing periods A and B + C, there was a significant reduction in the incidence of bleeding from 1.92% to 0.24% (P=.007), and postoperative complications in the airway that required tracheotomy from 1.28% to 0% (P=.012). The reductions in the incidence of RLN paralysis (from 1.32% to 0.8%, P=.45) and hypoparathyroidism (from 1.1% to 0.6%, P=.42) were not statistically significant. The number of annual events decreased from period A (odds ratio=3.51) to C (odds ratio=0.39).
CONCLUSIONS: Technical improvements in hemostasis, and identification of RLN, increase patient safety in thyroid surgery.