Development and Validation of a Synoptic Operative Report as a Quality Indicator for Thyroid Surgery: A Canadian Study.

BACKGROUND

Narrative operative reports (NORs) often lack key information that can guide postoperative management of thyroid disease. We aimed to develop and validate a nationally standardized synoptic operative report (SOR) for thyroid surgery.

MATERIALS AND METHODS

Surgeons were surveyed for their opinions of current operative reporting practices. Reportable elements from thyroidectomy NORs were ranked by thyroid disease specialists and reviewed by a national advisory committee to develop a standardized SOR using the Modified Delphi Method. Six thyroid surgeons piloted the SOR. Completeness and reporting frequencies of SOR elements were compared with pre-pilot NORs using Wilcoxon rank sum, chi-squared, and Fisher's exact analyses. A post-pilot survey assessed provider satisfaction.

RESULTS

Among 42 Canadian thyroid surgeons from 9 provinces, 31% expressed dissatisfaction with current reporting practices and 100% expressed interest in a SOR. In total, 109 reportable thyroidectomy elements were collected from 142 NORs and ranked by 46 thyroid disease specialists. Consensus agreed upon a 21-element SOR by a national advisory committee. Among 172 NORs and 170 piloted SORs, SORs had higher median overall completeness (100% [100-100%]) than NORs (65% [47-70%], p < 0.001). SORs improved reporting of cancer-specific elements, including the presence of gross extrathyroidal cancer extension (SOR: 100%, NOR: 43%, p < 0.001) and residual gross disease (SOR: 100%, NOR: 16%, p < 0.001). More than half of users and readers reported improved reporting completeness and impact on patient care with SORs.

CONCLUSIONS

Implementation of a nationally developed thyroid surgery SOR enhanced completeness, delivery of cancer-specific information, and provider satisfaction, which can improve quality of patient care.