Surgery of benign thyroid disease by ENT/head and neck surgeons and general surgeons: 233 cases of vocal fold paralysis in 3509 patients.

PURPOSE: Thyroid surgery is mainly performed by general surgeons (GS). The aim of this study is to evaluate the safety and efficiency of thyroid surgery by ENT/head and neck surgeons (ENT), especially regarding the incidence of vocal fold palsy (VFP). METHODS: We retrospectively analysed 3509 patients (69.0% female) who underwent surgery for benign thyroid diseases (56.8% nodular goitre, 18.6% inactive nodes, 14.0% thyroid autonomy, 7.0% Graves' disease). Operations were mainly performed with intraoperative neuromonitoring by GS (n = 1933) or physicians trained for head and neck surgery (n = 1576). 18.7% of the procedures were carried out by residents in training. RESULTS: VFP occurred in 233 subjects (6.6%); 6.2% in females and 7.6% in males. A lower rate (p < 0.001) was observed in operations performed by ENT (4.7%) than by GS (8.2%). No increased incidence of VFP was seen for surgeries performed by physicians in training (6.2%, n = 657). Prevalence of VFP was not different for minimally invasive (6.3%, n = 950) and conventional surgery (6.8%, n = 2559), but higher in total (7.2%, n = 1916) than in subtotal thyroidectomy (5.0%, n = 997). Postoperative haemorrhage (5.6 vs. 1.9%) and hypocalcaemia < 2.0 mmol/l (32.8 vs. 22.0%) were documented more frequently in patients with VFP, also substitution therapy with calcium (23.2 vs. 14.7%) and dihydrotachysterol (8.1 vs. 3.7%) had to be applied more frequently. CONCLUSION: Thyroid surgery performed by surgeons specifically trained for ENT/head and neck surgery is safe and has a significantly reduced rate of VFP. VFP is associated with other complications (postoperative haemorrhaging, hypocalcaemia).

[Patient Satisfaction as a Measure of Quality of Patient Care - Comparison between a University Hospital and a General Hospital]. / Patientenzufriedenheit als Maßeinheit im Qualitätsmanagement ­ ein Vergleich zwischen einem Universitätsklinikum und einem Krankenhaus der Regelversorgung.

Objective: The aim of the study was to compare the satisfaction of patients of a general hospital with a university hospital. A patient satisfaction index was calculated based on the assessed levels of satisfaction. In general, higher satisfaction could lead to increased competitiveness and improved cost efficiency for achieving profitability. Methods: The authors developed and administered a questionnaire on distinct parameters presumed to reflect the quality of the hospital stay to patients of a university hospital (University Hospital of Bonn, UKB, 1 224 beds) and a general hospital (Johanniterkrankenhaus, Bonn, JKH, 364 beds). Data were collected anonymously. Patient satisfaction and the relative importance of each parameter were assessed. The quotient of both parameters yields the patient satisfaction index (PZI). In order to account for possible differences in patient demands, statistical analysis was performed. Results: The demands and wishes, satisfaction and importance of the retrieved parameters did not differ significantly between the patients of the hospitals in any of aspects assessed (information, participation, contact and comfort during the hospital-stay). The study showed that communication and the contact to physicians and nurses was significantly more important for the patients than comfort (each p<0.001). The highest PZI were found in the categories entertainment (UKB 1.02; JKH 1.25) and contact to the nursing personnel (PZI UKB 0.94; PZI JKH 0.96). The standard of medical-technical care (UKB 0.93; JKH 0.95) was also highly ranked by patients of both hospitals. Needs for improvement related especially to the communication of errors (UKB 0.33; JKH 0.31). Discussion: Surveillance of patient wishes and criticism may result in a more patient-oriented care on a daily basis. Scrutinizing the resources employed may lead to more efficient use of resources and personnel and thus help cut costs and improve the attractiveness of hospitals.