H Dralle1. 1. Universitätsklinik für Allgemein-, Viszeral- und Gefäßchirurgie, Medizinische Fakultät, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland, henning.dralle@uk-halle.de.
Abstract
BACKGROUND: The extent, magnitude and technical equipment used for thyroid surgery has changed considerably in Germany during the last decade. The number of thyroidectomies due to benign goiter have decreased while the extent of thyroidectomy, nowadays preferentially total thyroidectomy, has increased. Due to an increased awareness of surgical complications the number of malpractice claims is increasing. OBJECTIVES: In contrast to surgical databases the frequency of complications in malpractice claims reflects the individual impact of complications on the quality of life. In contrast to surgical databases unilateral and bilateral vocal fold palsy are therefore at the forefront of malpractice claims. As guidelines are often not applicable for the individual surgical expert review, the question arises which are the relevant criteria for the professional expert witness assessing the severity of the individual complication. RESULTS: While in surgical databases major complications after thyroidectomy, such as vocal fold palsy, hypoparathyroidism, hemorrhage and infections are equally frequent (1-3 %), in malpractice claims vocal fold palsy is significantly more frequent (50 %) compared to hypoparathyroidism (15 %), hemorrhage and infections (about 5 % each). To avoid bilateral nerve palsy intraoperative nerve monitoring has become of utmost importance for surgical strategy and malpractice suits alike. For surgical expert review documentation of individual risk-oriented indications, the surgical approach and postoperative management are highly important. CONCLUSION: Guidelines only define the treatment corridors of good clinical practice. Surgical expert reviews in malpractice suits concerning quality of care and causality between surgical management, complications and sequelae of complications are therefore highly dependent on the grounds and documentation of risk-oriented indications for thyroidectomy, intraoperative and postoperative surgical management.
BACKGROUND: The extent, magnitude and technical equipment used for thyroid surgery has changed considerably in Germany during the last decade. The number of thyroidectomies due to benign goiter have decreased while the extent of thyroidectomy, nowadays preferentially total thyroidectomy, has increased. Due to an increased awareness of surgical complications the number of malpractice claims is increasing. OBJECTIVES: In contrast to surgical databases the frequency of complications in malpractice claims reflects the individual impact of complications on the quality of life. In contrast to surgical databases unilateral and bilateral vocal fold palsy are therefore at the forefront of malpractice claims. As guidelines are often not applicable for the individual surgical expert review, the question arises which are the relevant criteria for the professional expert witness assessing the severity of the individual complication. RESULTS: While in surgical databases major complications after thyroidectomy, such as vocal fold palsy, hypoparathyroidism, hemorrhage and infections are equally frequent (1-3 %), in malpractice claims vocal fold palsy is significantly more frequent (50 %) compared to hypoparathyroidism (15 %), hemorrhage and infections (about 5 % each). To avoid bilateral nerve palsy intraoperative nerve monitoring has become of utmost importance for surgical strategy and malpractice suits alike. For surgical expert review documentation of individual risk-oriented indications, the surgical approach and postoperative management are highly important. CONCLUSION: Guidelines only define the treatment corridors of good clinical practice. Surgical expert reviews in malpractice suits concerning quality of care and causality between surgical management, complications and sequelae of complications are therefore highly dependent on the grounds and documentation of risk-oriented indications for thyroidectomy, intraoperative and postoperative surgical management.
Authors: H Dralle; K Lorenz; P Schabram; T J Musholt; C Dotzenrath; P E Goretzki; J Kußmann; B Niederle; C Nies; J Schabram; C Scheuba; D Simon; T Steinmüller; A Trupka Journal: Chirurg Date: 2013-12 Impact factor: 0.955
Authors: Henning Dralle; Thomas J Musholt; Jochen Schabram; Thomas Steinmüller; Andreja Frilling; Dietmar Simon; Peter E Goretzki; Bruno Niederle; Christian Scheuba; Thomas Clerici; Michael Hermann; Jochen Kußmann; Kerstin Lorenz; Christoph Nies; Peter Schabram; Arnold Trupka; Andreas Zielke; Wolfram Karges; Markus Luster; Kurt W Schmid; Dirk Vordermark; Hans-Joachim Schmoll; Reinhard Mühlenberg; Otmar Schober; Harald Rimmele; Andreas Machens Journal: Langenbecks Arch Surg Date: 2013-03-03 Impact factor: 3.445
Authors: Amy Y Chen; Victor J Bernet; Sally E Carty; Terry F Davies; Ian Ganly; William B Inabnet; Ashok R Shaha Journal: Thyroid Date: 2014-01-20 Impact factor: 6.568
Authors: Glendon Michael Gardner; Matthew Michael Smith; Kathleen Lynn Yaremchuk; Ed Lawrence Peterson Journal: Laryngoscope Date: 2013-06 Impact factor: 3.325
Authors: Alvaro Sanabria; Adonis Ramirez; Luiz P Kowalski; Carl E Silver; Ashok R Shaha; Randall P Owen; Carlos Suárez; Avi Khafif; Alessandra Rinaldo; Alfio Ferlito Journal: Eur Arch Otorhinolaryngol Date: 2013-05-17 Impact factor: 2.503
Authors: Antje E Gohrbandt; Anna Aschoff; Bernhard Gohrbandt; Annemarie Keilmann; Hauke Lang; Thomas J Musholt Journal: World J Surg Date: 2016-03 Impact factor: 3.352
Authors: Thomas von Ahnen; Ulrich Wirth; Martin von Ahnen; Julia Kroenke; Peter Busch; Hans-Martin Schardey; Stefan Schopf Journal: Surg Endosc Date: 2021-01-11 Impact factor: 4.584