Deviation in the Standard of Surgical Care During Neck Surgery (Cervical Spine)

Evaluate breaches in the standard of care when determining the Deviation in the Standard of Surgical Care During Neck Surgery (Cervical Spine)

Answer the following questions to find out if the standard of care was followed for your case.

  • Which of the following surgeries did the patient undergo?
    Cervical spine surgery
    Laryngectomy
    Thyroid surgery
    Why is this important?
    Total laryngectomy remains the standard by which other forms of treatment for advanced primary laryngeal carcinoma are evaluated. It must still be considered as a primary treatment modality for selected patients.
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  • With which of the following indications for thyroid surgery did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    The indication for surgery is determined by an endocrinologist and a surgeon specialized in thyroid surgery. A thyroidectomy is performed for several indications including thyroid toxicity, nodules indicating equivocal or suspicious cytology, thyroid cancer and thyroid masses causing compression symptoms such as respiratory distress, voice changes and dysphagia.
    (2011) 29 ESURGO 9 446-450

  • Was a medical history obtained? Why is this important?
    Answer this question
    Past medical history (PMH) includes all past and current illness, hospitalizations, surgery, trauma, allergies, and medications.
    (2011) 55 EDECNA 1 15-28

  • Was a physical examination performed? Why is this important?
    Answer this question
    A preoperative basic health assessment is typically performed within 30 days of planned surgery. At least a limited assessment is mandated by the Joint Commission on Accreditation of Healthcare Organizations on all patients, but a more thorough evaluation is necessary to obtain a comprehensive view of patient risk factors.
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  • Was a Thyroid Function Test (TFT) performed? Why is this important?
    Answer this question
    The status of the patient’s thyroid gland needs to be assessed by obtaining thyroid function studies. A serum calcium level is useful for identifying patients who may have parathyroid disease in conjunction with thyroid disease.
    (2011) 29 ESURGO 9 446-450

  • Which of the following did the thyroid function studies reveal? Why is this important?
    Answer this question
    The thyroid surgery needs to be performed when the thyroid levels of the patient are normal. Patients with increased thyroid levels are at risk for developing thyroid storm, a condition that usually occurs during or after the procedure. Patients with hyperthyroidism who are to undergo thyroid surgery be treated with anti-thyroid drugs.
    (2011) 29 ESURGO 9 446-450

  • With which of the following was the patient diagnosed? Why is this important?
    Answer this question
    The diagnosis of multiple endocrine neoplasia type II (MEN2A or MEN2B) or familial medullary thyroid cancer (FMTC) is considered in patients with medullary carcinoma of the thyroid.
    (2011) 49 ERDCNA 3 463-471

  • Were pre-operative serum calcitonin and carcinoembryonic antigen levels obtained? Why is this important?
    Answer this question
    Pre-operative serum calcitonin and carcinoembryonic antigen levels should be obtained to evaluate for C-cell hyperplasia and medullary thyroid carcinoma.
    (2011) 49 ERDCNA 3 463-471

  • Which of the following diagnostic imaging studies were performed?(Choose all that apply) Why is this important?
    Answer this question
    A neck ultrasound needs to be routinely obtained to evaluate thyroid size and characteristics in all patients with suspected thyroid nodule, goiter or thyroid abnormality. The patient should also be evaluated for cervical lymphadenopathy.
    (2011) 29 ESURGO 9 446-450

  • Was a pre-operative laryngoscopy advised? Why is this important?
    Answer this question
    Injury to the recurrent laryngeal nerve is of concern during a thyroidectomy. Pre-operative laryngoscopy must be performed in patients with hoarseness or voice changes in pre-operative period and for all patients undergoing revision surgery, even in those who have had previous neck or mediastinal surgery unrelated to the thyroid.
    (2011) 49 ERDCNA 3 463-471

  • Was an informed consent obtained? Why is this important?
    Answer this question
    The laws of most states require that surgeons obtain informed consent before providing treatment.
    (2011) 23 EOMSCA 3 475-484

  • Which of the following complications did the patient experience? (Choose all that apply) Why is this important?
    Answer this question
    Thyroidectomy is a rather safe operation, as long as rigid technical principles are followed. A complete anatomic knowledge not only of the normal anatomy of the central visceral compartment of the neck but also of the common variations regarding the laryngeal nerves and the parathyroid glands is essential.
    (2003) 36 EOTCNA 1 159-187

  • How were the post-operative complications managed? (Choose all that apply) Why is this important?
    Answer this question
    Early recognition and prompt initial management of complications are equally important to a successful outcome. The most debilitating complications of thyroid surgery are recurrent laryngeal nerve injury and hypocalcemia. Other less frequent but significant complications includes hematoma, seroma, nerve injury, and wound infection.
    (2008) 17 ESOCNA 1 93-120

  • Which of the following measures were taken to manage the hematoma?(Choose all that apply) Why is this important?
    Answer this question
    Post-operatively, the patient needs to be monitored for any swelling of the neck, shortness of breath, increased heart rate, and any sign of infection.
    (2011) 49 ERDCNA 3 463-471

  • Which of the following diagnostic laboratory investigations were performed post-operatively?(Choose all that apply) Why is this important?
    Answer this question
    Calcium and parathyroid hormone tests need to be performed between 6 and 24 hours post-operatively.
    (2003) 36 EOTCNA 1 159-187

  • Were discharge instructions provided to the patient? Why is this important?
    Answer this question
    Patients undergoing total thyroidectomy are at risk for developing transient or permanent hypoparathyroidism post-operatively. The patients must be discharged with instructions to call in the event of neck swelling, bleeding, or tingling sensation around the mouth and fingertips.
    (2010) 43 EOTCNA 2 273-283

  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    Transient post-operative hoarseness is common after endotracheal intubation during surgery. Persisting or severe hoarseness is usually due to vocal cord paresis possibly due to recurrent laryngeal nerve injury.
    (2011) 49 ERDCNA 3 463-471

  • Which of the following supplements were prescribed? (Choose all that apply) Why is this important?
    Answer this question
    Following thyroid removal, thyroid hormone replacement is required for life. Patients may need several weeks of oral calcium and vitamin D until parathyroid function recovers.
    (2011) 49 ERDCNA 3 463-471

  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    Routine follow-up evaluations are necessary to offset any complications that may arise.
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