Carty, Sally E.

ABSTRACT Introduction The American Association of Endocrine Surgeons (AAES) drafted Entrustable Professional Activities (EPAs) for Endocrine Surgery (ES) to assess general surgery residents and ES fellows in core topics. Here, we examine learner and teacher concordance of entrustability ratings. Methods Fourteen EPAs were defined (10 “core”–6 with pre‐, intra‐, and post‐operative phases, four single‐phase–and four elective EPAs). Ten institutions collected three‐item micro‐assessments (MAs) of learner EPA performance using a web‐based platform, where entrustment was assessed on observable behaviors using a five‐point scale. Learner provided self‐assessment ratings, while teachers separately assigned ratings for the same activities. Spearman rank correlation tests were applied to compare learner‐teacher ratings for EPAs. Results MAs ( n = 698) were submitted between 7/2022‐9/2023. Programs submitted between 3 and 468 MAs. Among 3‐phase core EPAs, the intraoperative phase was most assessed ( n = 496), followed by pre‐ and post‐operative phases ( n = 108 and 55, respectively). Thirty‐nine single‐phase EPAs were submitted. Learner self‐assessment and teacher ratings were equivalent for 32% of pre‐operative EPAs, 53% of intra‐operative EPAs, 29% of post‐operative EPAs, and 64% of single phase of care EPAs. Spearman rank correlation between teacher and learner ratings for all phases of care combined was 0.66. Correlation was highest for the intra‐operative phase (0.73), followed by single‐phase (0.65), pre‐operative phase (0.27), and post‐operative phase (0.20). Rating concordance did not differ when high and low scores were examined independently. Learners were more prone to underestimate performance than to overestimate it when ratings were discordant. Conclusions Learners' self‐assessment and teacher ratings of endocrine surgery EPAs are strongly concordant with operative technical skills. However, learners often underestimate their performance of pre‐ and post‐operative care compared to faculty ratings when using EPAs.

ABSTRACTIntroductionThe outcomes of completion thyroidectomy are not well‐documented. The study aim is to compare the risks of total thyroidectomy (TT), thyroid lobectomy (TL), and completion thyroidectomy (CT) using a large multi‐institutional database.MethodsAll cases of thyroidectomy without lymphadenectomy were identified using the CESQIP national database (2013–2023). Completion thyroidectomy was defined as contralateral lobectomy following previous lobectomy. Outcomes were examined including hematoma requiring evacuation, vocal cord dysfunction on post‐op laryngoscopy, and clinical concern for hypoparathyroidism.ResultsAmong 33,154 cases, TT, TL, and CT were performed in 19,057 (57%), 13,135 (40%) and 962 (3%), respectively. 30‐day hematoma rates were overall low: 135 (0.8%) in TT, 57 (0.5%) in TL, and < 10 (0.7%) in CT (p < 0.01). 30‐day vocal cord dysfunction was documented in 233 (1.4%), 159 (1.3%), and < 10 (1.0%) for TT, TL, and CT, respectively (p = 0.65). Temporary hypoparathyroidism was more common after TT than CT (989 (6%) versus 20 (2%), p < 0.01). Among 16,311 (49%) patients with reported long‐term outcomes, there were no differences in the rates of vocal cord dysfunction by type of operation (p = 0.34). However, long‐term hypoparathyroidism was more likely after TT than CT (237 (2.5%) versus < 10 (0.7%), p < 0.01).ConclusionIn this multi‐institutional endocrine surgery database, the reported long‐term complication rates after completion thyroidectomy were the same as for first‐time thyroid lobectomy. However, clinical hypoparathyroidism was 2.5‐fold more likely for total thyroidectomy than for completion thyroidectomy at 30‐days and remained 3.7‐fold higher in the long term suggesting that completion thyroidectomy does not pose a higher risk of complications.

Background: Recent advances in research on thyroid carcinogenesis have yielded applications of diagnostic molecular biomarkers and profiling panels in the management of thyroid nodules. The specific utility of these novel, clinically available molecular tests is becoming widely appreciated, especially in perioperative decision making by the surgeon regarding the need for surgery and the extent of initial resection. Methods: A task force was convened by the Surgical Affairs Committee of the American Thyroid Association and was charged with writing this article. Results/Conclusions: This review covers the clinical scenarios by cytologic category for which the thyroid surgeon may find molecular profiling results useful, particularly for cases with indeterminate fine-needle aspiration cytology. Distinct strengths of each ancillary test are highlighted to convey the current status of this evolving field, which has already demonstrated the potential to streamline decision making and reduce unnecessary surgery, with the accompanying benefits. However, the performance of any diagnostic test, that is, its positive predictive value and negative predictive value, are exquisitely influenced by the prevalence of cancer in that cytologic category, which is known to vary widely at different medical centers. Thus, it is crucial for the clinician to know the prevalence of malignancy within each indeterminate cytologic category, at one's own institution . Without this information, the performance of the diagnostic tests discussed below may vary substantially.

Background: Goiter, or benign enlargement of the thyroid gland, can be asymptomatic or can cause compression of surrounding structures such as the esophagus and/or trachea. The options for medical treatment of euthyroid goiter are short-lived and are limited to thyroxine hormone suppression and radioactive iodine ablation. The objective of this statement article is to discuss optimal surgical management of goiter. Methods: A task force was convened by the Surgical Affairs Committee of the American Thyroid Association and was tasked with writing of this article. Results/Conclusions: Surgical management is recommended for goiters with compressive symptoms. Symptoms of dyspnea, orthopnea, and dysphagia are more commonly associated with thyromegaly, in particular, substernal goiters. Several studies have demonstrated improved breathing and swallowing outcomes after thyroidectomy. With careful preoperative testing and thoughtful consideration of the type of anesthesia, including the type of intubation, preparation for surgery can be optimized. In addition, planning the extent of surgery and postoperative care are necessary to achieve optimal results. Close collaboration of an experienced surgical and anesthesia team is essential for induction and reversal of anesthesia. In addition, this team must be cognizant of complications from massive goiter surgery such as bleeding, airway distress, recurrent laryngeal nerve injury, and transient hypoparathyroidism. With careful preparation and teamwork, successful thyroid surgery can be achieved.