Efficacy of Intraoperative Recurrent Laryngeal Nerve Monitoring: A Single-Institutions’ Experience

Objective: To evaluate the efficacy of intraoperative nerve monitoring (IONM) during thyroidectomy in preventing recurrent laryngeal nerve (RLN) injury. Design: Retrospective cohort study. Setting: Academic institution. Patients: Consecutive sample of subjects undergoing thyroidectomy by experienced endocrine surgeons between 2006 and 2008 at a single institution. Intervention: Intraoperative RLN monitoring. Main outcome measure: RLN injury. Results: Between 2006 and 2008, 296 subjects underwent thyroid lobectomy or total thyroidectomy by the authors. One patient was excluded because of preoperative documentation of RLN injury. IONM was used in 253 (88%) cases, with a total of 403 nerves at risk of injury. Loss of RLN signal following surgical dissection occurred in 13 cases, prompting a change in surgical plan in one case. Post-operative laryngoscopy was performed in eight patients with hoarseness, documenting vocal cord paralysis in one patient who had clear intraoperative anatomic evidence of RLN injury. In no case did loss of RLN signal after dissection lead to nerve injury in the absence of anatomical evidence of injury as detected by the surgeon. Conclusions: IONM added cost and resulted in surgeon angst in cases of malfunction without a clear benefit in RLN identification and protection. Anatomic identification of the RLN should remain the gold standard in preventing RLN injury during thyroidectomy

A New Look at the Volume and Outcome Relationship in Surgery for Colorectal Cancer

Purpose: Surgeon and hospital factors have a significant impact on treatment outcomes for colorectal cancer (CRC). Limited research has been done to assess cost and quality of treatment by surgeon-volume. We aim to identify the surgeon factors impacting cost and quality of surgical care for CRC. Methods: The University HealthSystem Consortium database was queried for patients who underwent colon resection for cancer from 2008 to 2012. Patients were grouped by surgeon-volume. Outcomes of interest were postoperative complications, ICU admission, readmission rate, inpatient hospital length of stay (LOS) and direct hospital cost. Average surgeon-volume per year was categorized as high (\u3e6) or low (16) based on the distribution of surgeon-volume. Results: 29,972 patients over age 18 were identified for inclusion. 25,426 underwent resection by high-volume surgeons (HVS) and 4,547 by low-volume surgeons (LVS). LVS were more likely to admit patients to the ICU than HVS (21% v 33%, p Conclusions: Surgeons who perform greater than 6 colectomies per year for colon cancer are more likely to use laparoscopy, less likely to admit patients to the ICU, have lower complication and readmission rates, and shorter LOS. Hospital cost is significantly lower in patients operated on by high volume surgeons. As health care costs continue to escalate and health care reform efforts gain momentum, factors leading to high-quality, cost-effective care need to be identified