gms | German Medical Science

86th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

13.05. - 16.05.2015, Berlin

How guidelines change practice – an evaluation of thyroid and parathyroid surgery in two UK centres.

Meeting Abstract

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  • corresponding author Thomas Saunders - UHNS NHS Trust, Market Drayton, United Kingdom
  • Suliman El-Shunnar - Health Education West Midlands, Birmingham, United Kingdom

Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie. 86. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie. Berlin, 13.-16.05.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15hnod144

doi: 10.3205/15hnod144, urn:nbn:de:0183-15hnod1446

Published: March 26, 2015

© 2015 Saunders et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License. You are free: to Share - to copy, distribute and transmit the work, provided the original author and source are credited. See license information at



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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