The incidence of thyroid cancer continues to increase, and both surgery for benign and malignant disease carries an important and persistent incidence of perioperative complications. This paper reports the results of an electronic survey sent to members of seven surgical and otolaryngology societies around the world, looking at the areas of perioperative practices which continue to vary between practitioners. A return rate of 23% involved complete survey responses from 693 surgeons who undertake thyroid surgery from 52 countries on six continents. This makes it one of the largest surveys of its kind of any surgical specialty association. Fifty-eight percent were from North America and 21% from Europe. Preoperative practices focused on surgeon-performed preoperative ultrasound (33%, the majority from Asia) and pre-op vocal cord checks (75% overall). The number performing postoperative vocal cord checks fell to 52%, with a strong correlation between those performing pre-op checks also monitoring cord function postoperatively. Intraoperative nerve monitoring was undertaken by 52% of respondents, with significantly more being ENT rather than general surgeons, and the vast majority using an endotracheal tube monitor. Only 8% reported using minimally-invasive video-assisted thyroidectomy, and only 5% using distant (mainly axillary) approaches. More than half of the latter respondents were based in Asia. Interesting variations were found worldwide in the routine use of postoperative drain placement for thyroid lobectomies. Europe and Asia had the highest incidence, with 38% and 48% of respondents respectively from those regions. For total thyroidectomy 572/693 reported placing a drain in their practice. Length of stay after a thyroid lobectomy showed that day-case surgery was performed by one third of respondents, of which 58% were based in the USA. This dropped to 7% for total thyroidectomy surgery. The results of this survey make for interesting reading, particularly in terms of putting the UK experience in context of how thyroid surgery is practised currently across the globe, by both ENT and general surgeons.

Perioperative practices in thyroid surgery: an international survey.
Maniakas A, Christopoulos A, Bissada E, et al.
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Aileen Lambert

Great Ormond Street Hospital, London, UK.

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