Preoperative Difficulty Index for Thyroidectomy (PreoDIT™): A Novel, Reliable, Content Valid, and Valuable Tool

Authors

  • Talat Waseem
  • Zaitoon Zafar Shalamar Medical and Dental College
  • Safia Zahir Ahmed
  • M Hasham Ashraf

DOI:

https://doi.org/10.48111/2021.04.03

Keywords:

thyroidectomy, endocrine surgery, surgical oncology, quality improvement, PreoDIT

Abstract

Background: A thyroidectomy can be a complex operation, currently there are no preoperative tools available to predict cases which may prove to be challenging procedures, or tools to grade potential thyroid procedures according to difficulty, based on a pre-operative assessment. The aim of this study is to develop such a tool; the Preoperative Difficulty Index for Thyroidectomy (PreoDIT™) and assess its reliability and validity.

Materials and methods: To define factors contributing to the complexity of a thyroidectomy, qualitative methods were used to retrieve qualitative data, in addition to an extensive literature review. A focus group was arranged in which a panel of 8 experts with extensive experience in thyroid surgery participated; and a tool, PreoDIT™, was developed. This tool was then utilized on 513 patients to test it’s reliability, validity and efficiency.

Results: PreoDIT™ scores strongly correlated with operative times, blood loss and postoperative complications; proving the reliability of this novel tool.

Conclusion: PreoDIT™ is a reliable and valid tool to measure the difficulty index of a thyroidectomy. This tool was designed to help surgeons optimize and manage their teams, operation theatre resources and resident training in a more objective way, before committing to a procedure.

References

Sarkar S, Banerjee S, Sarkar R, Sikder B. A Review on the History of ‘Thyroid Surgery.’ Indian J Surg. 2016;78(1):32. doi:10.1007/S12262-015-1317-5

Snyder SK, Hamid KS, Roberson CR, et al. Outpatient thyroidectomy is safe and reasonable: experience with more than 1,000 planned outpatient procedures. J Am Coll Surg. 2010;210(5):575-582. doi:10.1016/J.JAMCOLLSURG.2009.12.037

Consorti F, Milazzo F, Notarangelo M, Scardella L, Antonaci A. Factors influencing the length of the incision and the operating time for total thyroidectomy. BMC Surg. 2012;12(1):1-4. doi:10.1186/1471-2482-12-15/TABLES/2

McManus C, Luo J, Sippel R, Chen H. Is thyroidectomy in patients with Hashimoto thyroiditis more risky? J Surg Res. 2012;178(2):529-532. doi:10.1016/j.jss.2012.09.017

Upile T, Jerjes W, Mahil J, et al. How to do it: The difficult thyroid. Head Neck Oncol. 2011;3(1):1-11. doi:10.1186/1758-3284-3-54/TABLES/1

Wilhelm SM, McHenry CR. Total thyroidectomy is superior to subtotal thyroidectomy for management of graves’ disease in the United States. World J Surg. 2010;34(6):1261-1264. doi:10.1007/S00268-009-0337-3

Duclos A, Peix JL, Colin C, et al. Influence of experience on performance of individual surgeons in thyroid surgery: prospective cross sectional multicentre study. BMJ. 2012;344(7843). doi:10.1136/BMJ.D8041

Mazeh H, Chen H. Advances in surgical therapy for thyroid cancer. Nat Rev Endocrinol. 2011;7(10):581-588. doi:10.1038/nrendo.2011.140

Hannan SA. The magnificent seven: a history of modern thyroid surgery. Int J Surg. 2006;4(3):187-191. doi:10.1016/J.IJSU.2006.03.002

Mok VM, Oltmann SC, Chen H, Sippel RS, Schneider DF. IDENTIFYING PREDICTORS OF A DIFFICULT THYROIDECTOMY. J Surg Res. 2014;190(1):157. doi:10.1016/J.JSS.2014.03.034

Thyroidectomy N, Scale D, Times WO. Novel Thyroidectomy Difficulty Scale Correlates. 2014;38(8):1984-1989. doi:10.1007/s00268-014-2489-z.NOVEL

Patoir A, Payet C, Peix JL, et al. Determinants of operative time in thyroid surgery: A prospective multicenter study of 3454 thyroidectomies. PLoS One. 2017;12(7). doi:10.1371/JOURNAL.PONE.0181424

Bothra S, Sabaretnam M, Kannujia A, et al. Patient, thyroid, and surgeon related factors that make thyroidectomy difficult-cohort study. Ann Med Surg. 2020;49:14. doi:10.1016/J.AMSU.2019.11.010

D’Orazi V, Sacconi A, Trombetta S, et al. May predictors of difficulty in thyroid surgery increase the incidence of complications? Prospective study with the proposal of a preoperative score. BMC Surg. 2019;18(Suppl 1). doi:10.1186/S12893-018-0447-7

Tsai CH, Yang PS, Lee JJ, Liu TP, Kuo CY, Cheng SP. Effects of Preoperative Iodine Administration on Thyroidectomy for Hyperthyroidism: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg. 2019;160(6):993-1002. doi:10.1177/0194599819829052

Bajwa SJ, Sehgal V. Anesthesia and thyroid surgery: The never ending challenges. Indian J Endocrinol Metab. 2013;17(2):228. doi:10.4103/2230-8210.109671

Stevanovic KS, Sabljak VD, Toskovic AR, et al. The most difficult complications in thyroid surgery. Acta Medica Mediterr. 2017;2017(6):929-937. doi:10.19193/0393-6384_2017_6_147

Rosato L, Avenia N, Bernante P, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg. 2004;28(3):271-276. doi:10.1007/S00268-003-6903-1

Hardy R, Bliss R, Lennard T, Balasubramanian S, Harrison B, Dehn T. Management of Retrosternal Goitres. Ann R Coll Surg Engl. 2009;91(1):8. doi:10.1308/003588409X359196

Vieni S, Graceffa G, Rizzo GEM, Latteri F, Latteri MA, Cipolla C. An evaluation score of the difficulty of thyroidectomy considering operating time and preservation of recurrent laryngeal nerve. Updates Surg. 2019;71(3):569-577. doi:10.1007/S13304-018-0604-7

Kikuchi S, Perrier ND, Cheah WK, Siperstein AE, Duh QY, Clark OH. Complication of Thyroidectomy in Patients With Radiation-Induced Thyroid Neoplasms. Arch Surg. 2004;139(11):1185-1188. doi:10.1001/ARCHSURG.139.11.1185

Robert J, Mariéthoz S, Pache JC, et al. Short- and long-term results of total vs subtotal thyroidectomies in the surgical treatment of Graves’ disease. Swiss Surg. 2001;7(1):20-24. doi:10.1024/1023-9332.7.1.20

Ansaldo GL, Pretolesi F, Varaldo E, et al. Doppler evaluation of intrathyroid arterial resistances during preoperative treatment with Lugol’s iodide solution in patients with diffuse toxic goiter. J Am Coll Surg. 2000;191(6):607-612. doi:10.1016/S1072-7515(00)00755-9

Rodier JF, Janser JC, Petit H et al. [Effect of preoperative administration of Lugol’s solution on thyroid blood flow in hyperthyroidism] - PubMed. Ann Chir. 1998;52(3):229-233. Accessed November 19, 2021. https://pubmed.ncbi.nlm.nih.gov/9752450/

Mercier F, Bonal M, Fanget F, et al. Does Surgery Without Lugol’s Solution Pretreatment for Graves’ Disease Increase Surgical Morbidity? World J Surg. 2018;42(7):2123-2126. doi:10.1007/S00268-017-4443-3

Pollei TR, Barrs DM, Hinni ML, Bansberg SF, Walter LC. Operative time and cost of resident surgical experience: effect of instituting an otolaryngology residency program. Otolaryngol Head Neck Surg. 2013;148(6):912-918. doi:10.1177/0194599813482291

Kitzinger J. The methodology of Focus Groups: the importance of interaction between research participants. Sociol Health Illn. 1994;16(1):103-121. doi:10.1111/1467-9566.EP11347023

Struyf T, Tournoy J, Verbakel JY, Van den Bruel A. International Consensus Definition of a Serious Infection in a Geriatric Patient Presenting to Ambulatory Care. J Am Med Dir Assoc. 2020;21(5):578-582.e1. doi:10.1016/J.JAMDA.2020.01.015

Yusoff MSB, Abdul Rahman YR, Mohamed Rouse F. Strengthening Education in Medicine Journal Through Collaboration with Malaysian Association of Education in Medicine and Health Science (MAEMHS). Educ Med J. 2018;10(1):1-2. doi:10.21315/EIMJ2018.10.1.1

Giddings AEB. The history of thyroidectomy. J R Soc Med. 1998;91(Suppl 33):3. doi:10.1177/014107689809133S02

Agarwal A, Mishra AK, Gupta SK, et al. High incidence of tracheomalacia in longstanding goiters: Experience from an endemic goiter region. World J Surg. 2007;31(4):832-837. doi:10.1007/S00268-006-0565-8/TABLES/1

Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg. 1998;228(3):320-330. doi:10.1097/00000658-199809000-00005

Mittendorf EA, McHenry CR. Thyroidectomy for Selected Patients With Thyrotoxicosis. Arch Otolaryngol Neck Surg. 2001;127(1):61-65. doi:10.1001/ARCHOTOL.127.1.61

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Published

2022-01-03

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Original Research Communication

How to Cite

Preoperative Difficulty Index for Thyroidectomy (PreoDIT™): A Novel, Reliable, Content Valid, and Valuable Tool. (2022). Archives of Surgical Research, 2(4), 5-11. https://doi.org/10.48111/2021.04.03