[Hemostasis and neuromonitoring as patient safety measures in thyroid surgery].

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.