A systematic review of trainee involvement in thyroid surgery and the impact on patient outcomes

Abstract

: There has been a reduction in working hours for surgical trainees globally and this has led to a concern that competencies will not be achieved. There is evidence that suggests that trainee involvement in thyroid surgery can have both negative and positive effects on clinical outcomes. We aim to review the literature concerning trainee involvement in thyroid surgery and their impact on clinical outcomes. A search of online databases was performed to identify all studies comparing trainee to consultant involvement in thyroid surgery and assess the impact on clinical outcomes. The main outcomes of interest were hypocalcaemia rates, injury to the recurrent laryngeal nerve, operation time and bleeding rates. The results were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of the included studies was assessed and reported according to the Methodological Index for Non-Randomised Studies (MINORS) criteria. Ten studies were included in this review of 23,000 patients undergoing thyroid surgery. Four studies assessed all 4 outcomes as stated in our methods. Seven studies assessed hypocalcaemic and nerve injury rates and found no significant difference in hypocalcaemic and nerve injury rates (P>0.05). Six studies assessed re-bleeding rates and found no significant differences between trainees and consultants (P>0.05). Seven studies assessed operating times and 5 of these studies found trainee involvement was significantly associated with longer operating times (P>0.05). Supervised trainee involvement in thyroid surgery does not have a significant impact of hypocalcaemic, nerve injury and re-bleeding rates but does increase operating time. Given the positive impact on clinical outcomes, thyroid surgery can be safely performed by surgical trainees under supervision.