McIntyre, Charlotte1; Palazzo, Fausto1; Tolley, Neil1
1 Department of Endocrine and Thyroid Surgery, Imperial College Healthcare NHS Foundation Trust, St. Mary’s Hospital, London, UK
Background: In 2015-16, the National Health Service (NHS) Litigation Authority received 10,965 claims for clinical negligence with Surgery having the highest number of claims. Currently a sum amounting to 25% of the annual NHS budget has been ring-fenced to meet extant claims. Claims made on a basis of inadequate informed consent are increasingly seen with many achieving a successful plaintiff outcome. There are presently no UK guidelines for Thyroidectomy consent. This study analyzed Thyroidectomy practice in 192 UK Surgeons. All were British Association of Endocrine-Thyroid Surgeons (BAETS) members.
Methods: An anonymised SurveyMonkey questionnaire was sent to all BAETS Surgeons. Each selected from a list of complications those that they routinely consented patients for when performing: total thyroidectomy (Benign), total thyroidectomy (Cancer), hemi-thyroidectomy (no prior surgery) and a lateral selective neck dissection.
Results: 192 questionnaires were analyzed from a range of surgical disciplines. 51% were ENT, 22% Endocrine, 16% General, 9% Breast and 2% Maxillofacial. 93% of surgeons perform benign and cancer surgery.
For a total thyroidectomy (cancer), 99% consent for Recurrent Laryngeal Nerve (RLN) and voice change (temporary/permanent). 72% consent for External Laryngeal Nerve (ELN) injury. 51% consent for tracheostomy and 56% consent for risks of general anaesthetic and associated complications.
Discussion and Conclusion: Wide variability was found in the consenting practice of Thyroid surgeons in the UK. A BAETS approved consensus guideline to standardise the UK practice of consent may help reduce future complaints and litigation claims.