Hostname: page-component-77c89778f8-m42fx Total loading time: 0 Render date: 2024-07-20T13:01:01.087Z Has data issue: false hasContentIssue false
  • English
  • Français

Litigation in thyroid surgery: a pan-specialty review of National Health Service (UK) data

Published online by Cambridge University Press:  07 June 2023

James Arwyn-Jones Open the ORCID record for James Arwyn-Jones [Opens in a new window] ,
Talisa Ross ,
Annakan Navaratnam Open the ORCID record for Annakan Navaratnam [Opens in a new window] ,
Manish George ,
John T Machin ,
Tim W R Briggs  and
Neil Tolley
James Arwyn-Jones*
Affiliation:
Otolaryngology, Charing Cross Hospital, London, UK
Talisa Ross
Affiliation:
Otolaryngology, Royal London Hospital, London, UK University College London, London, UK
Annakan Navaratnam
Affiliation:
Otolaryngology, Charing Cross Hospital, London, UK
Manish George
Affiliation:
Otolaryngology, St Mary's Hospital, London, UK
John T Machin
Affiliation:
Orthopaedics, King's College Hospital, London, UK Getting It Right First Time Programme, NHS England, London, UK
Tim W R Briggs
Affiliation:
Getting It Right First Time Programme, NHS England, London, UK Royal National Orthopaedic Hospital, London, UK
Neil Tolley
Affiliation:
Otolaryngology, St Mary's Hospital, London, UK
*
Corresponding author: James Arwyn-Jones; Email: james.jones12@nhs.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Thyroid surgery carries risks that significantly impact patients. This paper describes the landscape of thyroid surgery related litigation claims in the National Health Service from April 2015 to April 2020, to establish learning points in order to improve patient care and minimise litigation risk.

Methods

Data were requested from National Health Service Resolution and Hospital Episode Statistics. Claims were classified into operative and non-operative causes. Subspecialty information, incident details and claim costings were analysed.

Results

Sixty claims were identified. Thirty-eight claims (63.3 per cent) were closed, with an average total claim cost of £68 816 and average damages paid of £36 349. Claims related to diagnostic issues were most common (n = 19); of claims associated with operative causes (n = 30), those relating to nerve injury were most common (n = 8), with issues of nerve monitoring and consent being cited.

Conclusion

Utilisation of well-established protocols will likely reduce litigation in thyroid surgery, as we move towards a landscape in which the patient journey is thoroughly scrutinised for targeted improvements.

Keywords

Thyroid glandthyroidectomyinformed consent
Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 11 , November 2023 , pp. 1200 - 1206
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

James Arwyn-Jones takes responsibility for the integrity of the content of the paper

References

NHS resolution annual report and accounts 2021/22. In: https://resolution.nhs.uk/wp-content/uploads/2022/07/NHS-Resolution-Annual-report-and-accounts-2021_22_Access.pdf [4 January 2022]Google Scholar
Understanding drivers of litigation in health services. In: https://www.york.ac.uk/media/healthsciences/images/research/prepare/UnderstandingDriversOfLitigationInHealthServices.pdf [4 January 2022]Google Scholar
Zevallos, JP, Hartman, CM, Kramer, JR, Sturgis, EM, Chiao, EY. Increased thyroid cancer incidence corresponds to increased use of thyroid ultrasound and fine-needle aspiration: a study of the Veterans Affairs health care system. Cancer 2015;121:741–6CrossRefGoogle ScholarPubMed
The British Association of Endocrine & Thyroid Surgeons sixth national audit report 2021. In: https://e-dendrite.com/Publishing/Reports/BAETS/Sixth_Audit_Report.pdf [28 February 2022]Google Scholar
Abdelhamid, A, Aspinall, S. Intraoperative nerve monitoring in thyroid surgery: analysis of United Kingdom registry of endocrine and thyroid surgery database. Br J Surg 2021;108:182–7CrossRefGoogle ScholarPubMed
Lessons learned from running a national thyroid surgery registry. In: https://www.entandaudiologynews.com/features/ent-features/post/lessons-learned-from-running-a-national-thyroid-surgery-registry [28 February 2022]Google Scholar
NHS Digital. Hospital Episode Statistics (HES). In: https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/hospital-episode-statistics [24 January 2022]Google Scholar
Swonke, ML, Shakibai, N, Chaaban, MR. Medical malpractice trends in thyroidectomies among general surgeons and otolaryngologists. OTO Open 2020;4:2473974X20921141CrossRefGoogle ScholarPubMed
Dent, PC, Bagnall, NM. Litigation in thyroid surgery in England. Br J Hosp Med 2017;78:213–18CrossRefGoogle ScholarPubMed
McIntyre, C, Tolley, N. A critical review of thyroidectomy consent in the UK. Int J Surg 2019;66:84–8CrossRefGoogle ScholarPubMed
Machin, JT, Hardman, J, Harrison, W, Briggs, TWR, Hutton, M. Can spinal surgery in England be saved from litigation: a review of 978 clinical negligence claims against the NHS. Eur Spine J 2018;27:2693–9CrossRefGoogle ScholarPubMed
Alsaffar, H, Wilson, L, Kamdar, DP, Sultanov, F, Enepekides, D, Higgins, KM. Informed consent: do information pamphlets improve post-operative risk-recall in patients undergoing total thyroidectomy: prospective randomized control study. J Otolaryngol Head Neck Surg 2016;45:14CrossRefGoogle ScholarPubMed
Ritter, A, Ganly, I, Wong, RJ, Randolph, GW, Shpitzer, T, Bachar, G et al. Intraoperative nerve monitoring is used routinely by a significant majority of head and neck surgeons in thyroid surgery and impacts on extent of surgery--survey of the American Head and Neck Society. Head Neck 2020;42:1757–64CrossRefGoogle ScholarPubMed
Ho, Y, Carr, MM, Goldenberg, D. Trends in intraoperative neural monitoring for thyroid and parathyroid surgery amongst otolaryngologists and general surgeons. Eur Arch Otorhinolaryngol 2013;270:2525–30CrossRefGoogle ScholarPubMed
Guidelines – British Association of Endocrine and Thyroid Surgeons. In: https://www.baets.org.uk/guidelines/ [9 June 2022]Google Scholar
Wu, CW, Huang, TY, Randolph, GW, Barczyński, M, Schneider, R, Chiang, FY et al. Informed consent for intraoperative neural monitoring in thyroid and parathyroid surgery -- consensus statement of the International Neural Monitoring Study Group. Front Endocrinol (Lausanne) 2021;12:795281CrossRefGoogle ScholarPubMed
Barczyński, M, Randolph, GW, Cernea, CR, Dralle, H, Dionigi, G, Alesina, PF et al. External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement. Laryngoscope 2013;123(suppl 4):S1–14CrossRefGoogle Scholar
Geraghty, A, Ferguson, L, McIlhenny, C, Bowie, P. Incidence of wrong-site surgery list errors for a 2-year period in a single National Health Service board. J Patient Saf 2020;16:79–83CrossRefGoogle Scholar
Iliff, HA, El-Boghdadly, K, Ahmad, I, Davis, J, Harris, A, Khan, S et al. Management of haematoma after thyroid surgery: systematic review and multidisciplinary consensus guidelines from the Difficult Airway Society, the British Association of Endocrine and Thyroid Surgeons and the British Association of Otorhinolaryngology, Head and Neck Surgery. Anaesthesia 2022;77:82–95CrossRefGoogle Scholar
Nouraei, SAR, Virk, JS, Middleton, SE, Aylin, P, Mace, A, Vaz, F et al. A national analysis of trends, outcomes and volume-outcome relationships in thyroid surgery. Clin Otolaryngol 2017;42:354–65CrossRefGoogle ScholarPubMed
Aspinall, S, Oweis, D, Chadwick, D. Effect of surgeons’ annual operative volume on the risk of permanent hypoparathyroidism, recurrent laryngeal nerve palsy and haematoma following thyroidectomy: analysis of United Kingdom registry of endocrine and thyroid surgery. Langenbecks Arch Surg 2019;404:421–30CrossRefGoogle ScholarPubMed
Gray, WK, Aspinall, S, Tolley, N, Day, J, Lansdown, M. The volume and outcome relationship for thyroidectomy in England. Langenbecks Arch Surg 2021;406:1999–2010CrossRefGoogle ScholarPubMed
Gray, WK, Navaratnam, AV, Day, J, Wass, JAH, Briggs, TWR, Lansdown, M. Volume-outcome associations for parathyroid surgery in England: analysis of an administrative data set for the Getting It Right First Time program. JAMA Surg 2022;157:581–8CrossRefGoogle ScholarPubMed
The Getting It Right First Time program, the Royal College of Surgeons and the British Association of Endocrine & Thyroid Surgeons: best practice for thyroidectomy documentation. In: https://www.gettingitrightfirsttime.co.uk/wp-content/uploads/2022/09/GIRFT-best-practice-thyroidectomy-Final-20220830.pdf [14 October 2022]Google Scholar