Evidence map›Paper›PMID 37130695›Full record

ArticleBMJ open quality2023

Preoperative and postoperative optimisation of patients undergoing thyroid surgery: a multicentre quality improvement project at Barts Health NHS Trust.

Matt Lechner, Gulwish Moghul, Deepak Chandrasekharan, Salman Ashraf, Oscar Emanuel, Tiarnan Magos, Zi Wei Liu, Margaret Crutchlow, Stephen Kinghorn, Gayle McDonnell and 11 more

Open access · goldAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open quality, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.9field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 6 citations in OpenAlex.

  1. Article
  2. Article
  3. Review
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors at 6 institutions in 2 countries.

Matt Lechner *Division of Surgery and Interventional Science & Cancer Institute, University College London, London, UK m.lechner@ucl.ac.uk k.ghufoor@nhs.net.
Gulwish Moghul *Department of Otolaryngology - Head and Neck Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK.
Deepak Chandrasekharan *Department of Otolaryngology - Head and Neck Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK.
Salman AshrafDepartment of Otolaryngology - Head and Neck Surgery, Whipps Cross University Hospitals, Barts Health NHS Trust, London, UK.
Oscar EmanuelDepartment of Otolaryngology - Head and Neck Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK.
Tiarnan MagosDepartment of Otolaryngology - Head and Neck Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK.
Zi Wei LiuDepartment of Otolaryngology-Head and Neck Surgery, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK.
Margaret CrutchlowPre-assessment Clinic, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK.
Stephen KinghornPre-assessment Clinic, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK.
Gayle McDonnellPre-assessment Clinic, Royal London Hospital, Barts Health NHS Trust, London, UK.
Harry McArdlePre-assessment Clinic, Royal London Hospital, Barts Health NHS Trust, London, UK.
Amr SalemDepartment of Otolaryngology - Head and Neck Surgery, Whipps Cross University Hospitals, Barts Health NHS Trust, London, UK.
Mike PapeschDepartment of Otolaryngology - Head and Neck Surgery, Whipps Cross University Hospitals, Barts Health NHS Trust, London, UK.
Kalpita MajumdarDivision of Endocrinology, Department of Medicine, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK.
Abdulfattah LakhdarDivision of Endocrinology, Department of Medicine, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK.
Safina AliDepartment of Otolaryngology - Head and Neck Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK.
Jahangir AhmedDepartment of Otolaryngology - Head and Neck Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK.
Ghassan AlusiDepartment of Otolaryngology - Head and Neck Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK.
Paul StimpsonHead and Neck Centre, University College London Hospitals NHS Trust, London, UK.
Mona WaterhouseDepartment of Endocrinology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
Khalid GhufoorDepartment of Otolaryngology - Head and Neck Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK m.lechner@ucl.ac.uk k.ghufoor@nhs.net.
Royal London Hospital · GBWhipps Cross University Hospital · GBBarts Health NHS Trust · GBUniversity College London · GBLondon North West Healthcare NHS Trust · GBSt Bartholomew's Hospital · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Hypocalcaemia following thyroid surgery can occur in up to 38% of patients. With over 7100 thyroid surgeries performed in 2018 in the UK, this is a common postoperative complication. Undertreated hypocalcaemia can result in cardiac arrhythmias and death. Preventing adverse events from hypocalcaemia requires preoperative identification and treatment of at-risk patients with vitamin D deficiency, timely recognition of postoperative hypocalcaemia and prompt appropriate treatment with calcium supplementation. This project aimed to design and implement a perioperative protocol for prevention, detection and management of post-thyroidectomy hypocalcaemia. A retrospective audit of thyroid surgeries (n=67; October 2017 to June 2018) was undertaken to establish baseline practice of (1) preoperative vitamin D levels assessment, (2) postoperative calcium checks and incidence of postoperative hypocalcaemia and (3) management of postoperative hypocalcaemia. A multidisciplinary team approach following quality improvement principles was then used to design a perioperative management protocol with all relevant stakeholders involved. After dissemination and implementation, the above measures were reassessed prospectively (n=23; April-July 2019). The percentage of patients having their preoperative vitamin D measured increased from 40.3% to 65.2%. Postoperative day-of-surgery calcium checks increased from 76.1% to 87.0%. Hypocalcaemia was detected in 26.8% of patients before and 30.43% of patients after protocol implementation. The postoperative component of the protocol was followed in 78.3% of patients. Limitations include low number of patients which precluded from analysis of the impact of the protocol on length of stay. Our protocol provides a foundation for preoperative risk stratification and prevention, early detection and subsequent management of hypocalcaemia in thyroidectomy patients. This aligns with enhanced recovery protocols. Moreover, we offer suggestions for others to build on this quality improvement project with the aim to further advance the perioperative care of thyroidectomy patients.

Indexed as

HypocalcemiaCalciumHumansQuality ImprovementRetrospective StudiesState MedicineThyroidectomyThyroid GlandVitamin DCalciumVitamin Dclinical auditclinical protocolscritical carepostoperative carepreoperative care

Identifiers

PMID37130695
PMCPMC10163442
OpenAlexW4367693274

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.