Does thyroid subspecialization alter practice and outcome? A completed 4-year audit loop

Objective: To assess the effect of subspecialization on thyroid surgical practice and outcome. Design: The multidisciplinary thyroid clinic was established in November 2000. A retrospective study of all thyroid surgery covering the period November 1998 to November 2000 was carried out. Best practice principles were implemented and prospective data were collected over a further 2 years to complete the audit loop. Practice and results were compared. Setting: The project was carried out through the Hull and East Yorkshire Multidisciplinary Thyroid Clinic, a tertiary referral clinic for the management of thyroid disease. Participants: All patients who underwent thyroid surgery through the Department of Otolaryngology Head and Neck Surgery for 2 years before the establishment of the thyroid clinic (39 patients) and all patients who underwent thyroid surgery through the department for 2 years after the establishment of the clinic (108 patients) were included. Main outcome measures: Referral patterns, preoperative workup, types of surgery, histopathological diagnosis and complications rates were compared. Results: The audit loop revealed that permanent vocal cord palsy rates had fallen from 8% to 0%, haematoma rates had fallen from 5% to 2% and permanent hypoparathyroidism rates had fallen from 8% to 2%. In addition, caseload had markedly increased, preoperative investigations were reduced and types of surgery standardized. Conclusion: It is clear that thyroid subspecialization is beneficial as far as overall outcome is concerned. However, this may lead to increased throughput which must be borne in mind for future activity planning.