The University of Sydney Endocrine Surgery Database: 50 years of data accrual.

Surgical databases are now a fundamental part of clinical practice and research but have only been commonplace in the past decade or so. The University of Sydney Endocrine Surgery Database has now been in existence for more than 50 years since it was started by Tom Reeve in 1957. It includes comprehensive documentation of every aspect of every thyroid, parathyroid and adrenal procedure carried out by its surgeons while they were active members of the unit. During those 50 years, 17,466 such procedures have been documented. In the first year of data collection, only 20 thyroid procedures carried out by one surgeon in one hospital were entered, whereas in the most recent year, 1092 major endocrine procedures carried out by three surgeons in 10 separate hospitals required entry. As well as providing for surgical audit, the database has been integral to the writing of 130 published articles and articles in press on the topic of thyroid, parathyroid and adrenal surgery. The database has been instrumental to significant changes in the practice of endocrine surgery, including introduction of total thyroidectomy for benign bilateral multinodular goitre by this unit two decades ago, leading to changed practice in most countries around the globe. Data acquisition has also allowed documentation of the safety and efficacy of new minimally invasive endocrine procedures such as minimally invasive parathyroidectomy and minimally invasive thyroid surgery. Audit-based research with accumulation of data based on surgical outcomes, that is, evidence-based surgery, remains the fundamental basis of sound surgical practice with the potential to lead important changes in clinical practice.