Can total thyroidectomy be performed as safely by general surgeons in provincial centers as by surgeons in specialized endocrine surgical units?
Total thyroidectomy is an operation that always engenders controversy relating to the morbidity of recurrent laryngeal nerve and parathyroid injury. Surgeons who have completed a well-designed training program and who have become proficient at total thyroidectomy as trainees will remain proficient at the procedure despite practicing in a provincial center. Achieving a low morbidity rate demands meticulous attention to operative technique and anatomical detail.
The discrepancy of results between the hospital and patient-level analyses suggests that the association of mortality and PGI in the patient-level analyses resulted from bias by indication. Hospital-level results provided no evidence of a benefit of PGI use on survival, but may have failed to detect a true benefit due to limited statistical power. Further use of PGI in this population should only be recommended after rigorous evaluation, such as a randomized controlled trial.