4.4 Article

Analysis and outcomes of wrong site thyroid surgery

Journal

BMC SURGERY
Volume 21, Issue 1, Pages -

Publisher

BMC
DOI: 10.1186/s12893-021-01247-7

Keywords

Wrong-site surgery; WSS; Malpractice; Medical errors; Patient safety; Thymectomy; Thymectomy instead of thyroidectomy; Wrong side; Wrong procedure; Wrong patient

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In a 20-year period, 5 cases of wrong-site surgery following thyroid surgery were reported, with subtypes including wrong target and wrong procedure. These surgeries mostly occurred in low-volume hospitals, leading to legal action or monetary settlement in some cases.
Background In thyroid surgery, wrong-site surgery (WSS) is considered a rare event and seldom reported in the literature. Case presentation This report presents 5 WSS cases following thyroid surgery in a 20-year period. We stratified the subtypes of WSS in wrong target, wrong side, wrong procedure and wrong patient. Only planned and elective thyroid surgeries present WSS cases. The interventions were performed in low-volume hospitals, and subsequently, the patients were referred to our centres. Four cases of wrong-target procedures (thymectomies [n = 3] and lymph node excision [n = 1] performed instead of thyroidectomies) and one case of wrong-side procedure were observed in this study. Two wrong target cases resulting additionally in wrong procedure were noted. Wrong patient cases were not detected in the review. Patients experienced benign, malignant, or suspicious pathology and underwent traditional surgery (no endoscopic or robotic surgery). 40% of WSS led to legal action against the surgeon or a monetary settlement. Conclusion WSS is also observed in thyroid surgery. Considering that reports regarding the serious complications of WSS are not yet available, these complications should be discussed with the surgical community. Etiologic causes, outcomes, preventive strategies of WSS and expert opinion are presented.

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