Lin Jin Xin, Wen Daniel, Sharma Avinash, van der Werf Bert, Martin Richard C W, Harman Richard
North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand.
Department of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
ANZ J Surg. 2021 Sep;91(9):1804-1812. doi: 10.1111/ans.17099. Epub 2021 Aug 17.
Complications following thyroid/parathyroid surgery include recurrent laryngeal nerve (RLN) injury, hypocalcaemia and return to theatre for haematoma evacuation. Rates of these form the basis of key performance indicators (KPI). An endocrine database, containing results from 1997, was established at the North Shore Hospital in Auckland, New Zealand. We aimed to measure complication rates by procedure (thyroid and parathyroid), explore a temporal change in our unit and compare our results against international literature.
A retrospective review of the database between July 1997 and February 2020 was performed. The results for each KPI were analysed in total and over consecutive time periods. A review of the literature was carried out to find international complication rates for comparison. A cumulative sum (CUSUM) analysis was performed to give visual feedback on performance.
There were 1062 thyroidectomies and 336 parathyroidectomies from July 1997 to February 2020. Thyroid surgery results found rates of temporary/permanent RLN injury of 1.9%/0.3%, temporary/permanent hypocalcaemia of 22.3/2.5%, and return to theatre for haematoma evacuation of 1.1%. Parathyroid surgery results were, temporary RLN injury of 0.8% (no permanent injury), temporary/permanent hypocalcaemia of 1.7%/0.4%, and return to theatre for haematoma evacuation of 0.3%. CUSUM analysis found KPI results to be comparable with international literature.
Our unit's KPI results are comparable to published results in the literature. The use of this clinical database will help in future monitoring of performance and help drive improvement in the service. Embedding prospective data collection as routine practice allows for continuous improvement for the unit.
甲状腺/甲状旁腺手术后的并发症包括喉返神经（RLN）损伤、低钙血症以及因血肿清除而返回手术室。这些并发症的发生率构成了关键绩效指标（KPI）的基础。新西兰奥克兰北岸医院建立了一个包含1997年以来结果的内分泌数据库。我们旨在按手术类型（甲状腺和甲状旁腺）测量并发症发生率，探讨我们科室的时间变化情况，并将我们的结果与国际文献进行比较。
对1997年7月至2020年2月期间的数据库进行回顾性分析。对每个KPI的结果进行总体分析以及连续时间段的分析。查阅文献以找到国际并发症发生率进行比较。进行累积和（CUSUM）分析以提供绩效的可视化反馈。
1997年7月至2020年2月期间共进行了1062例甲状腺切除术和336例甲状旁腺切除术。甲状腺手术结果显示，暂时性/永久性RLN损伤发生率为1.9%/0.3%，暂时性/永久性低钙血症发生率为22.3%/2.5%，因血肿清除而返回手术室的发生率为1.1%。甲状旁腺手术结果为，暂时性RLN损伤发生率为0.8%（无永久性损伤），暂时性/永久性低钙血症发生率为1.7%/0.4%，因血肿清除而返回手术室的发生率为0.3%。CUSUM分析发现KPI结果与国际文献相当。
我们科室的KPI结果与文献中公布的结果相当。使用该临床数据库将有助于未来对绩效的监测，并有助于推动服务改进。将前瞻性数据收集作为常规做法可使科室不断改进。
