Textbook outcome in thyroid surgery: A new approach to assess quality in an endocrine surgery unit

Thyroidectomy is a term encompassing various surgical procedures involving the thyroid gland. Assessing quality is imperative for patient safety and clinical auditing and textbook outcome (TO) offers more comprehensive information on overall quality than single indicators. This study aims to define the parameters constituting TO in thyroid surgery, evaluate the outcomes based on TO criteria within an endocrine surgery unit at a tertiary hospital, and identify factors associated with failure to achieve TO in these cases.

A retrospective observational study of consecutive patients undergoing thyroid surgery at the Endocrine Surgery Unit in Spain between January 2020 and December 2022. The analyzed variables included, among others, age and sex, comorbidities, diagnosis, intrathoracic goiter, type of thyroidectomy, and several postoperative complications. The first TO definition in thyroid surgery was made.

A total of 244 patients were included in the study. TOTS was achieved in 153 patients (62.7%), and there were no reported mortalities. Diabetes (18% vs 8.61%) and endothoracic goiter (40% vs 22%) were statistically associated with textbook outcome non-achievement. Also, the endothoracic goiter parameter was identified as a statistically significant predictor of textbook outcome non-achievement.

The implementation of the TO concept in thyroid surgery offers a comprehensive method for assessing surgical quality, encapsulating a range of critical postoperative outcomes. The rate of TO in our serie was 62.7%, identifying that endothoracic goiter is the main parameter of textbook outcome non-achievement.