gms | German Medical Science

In 2010 the American Academy of Otolaryngologists published their comprehensive guidelines into the care of patients undergoing thyroid and parathyroid surgery. It is reported that the most common post-opeative medical negligence claim is this field is related to Recurrent Laryngeal Nerve (RLN) damage. We investigated whether the new guidelines changed clinical practice in two UK hospitals, and whether more can be done to protect the departments from medico legal claims about post-operative complications involving damage to the RLNs.

We examined the records of 45 patients before the guidelines were published and 58 patients afterwards. We looked at pre-operative, intraoperative and post-operative investigations carried out by the surgical team to record the state of RLN function, to establish whether the guidelines had changed practice.

We found that clinical practice did change the amount of post-operative investigations performed by clinicians to establish the function of the RLNs. This took the form of increased informal voice evaluation (15% vs 24%) and increased use of endoscopy to formally assess function (20% vs 27%). The frequency of actual RLN palsy and patient reported voice abnormality did not significantly change during this time.

Although there has been some improvement, more can be done to ensure more cases fit best-practice guidelines and clinicians are more protected from medico legal claims.

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