20th March 2008
Dendrite announces the release of the Second National Audit Report of the BAETS
The British Association of Endocrine and Thyroid Surgeons (BAETS, previously the British Association of Endocrine Surgeons) is pleased to announce a new joint publication of the Second National Endocrine Surgery Audit Report, with Dendrite Clinical Systems. This latest publication documents the current status of endocrine surgery in the UK and provides valuable insights into the outcomes and workload of endocrine surgery and it is hoped this will assist in the planning and structure of training programmes for future endocrine surgeons.
"The aim of the Audit is to build a national picture of the practice of various pathologies. By recording the outcomes of investigations, operations and in particular complications, it allows members to compare their outcomes with National data," commented Mr David Scott-Coombes, Director of the BAETS Audit and Consultant in Endocrine Surgery at the University Hospital of Wales, Cardiff, UK. "In addition, by establishing individual workloads, the Audit provides information that we hope will encourage national debates, such as who should be a national training unit and how many centres are needed to undertake surgery for rare illnesses. The audit records the amount of surgical training that individual members provide. This latest report will show that the BAETS is a truly professional body demonstrating its commitment to audit."
Since the launch of BAETS' web-based data entry system in August 2005, some 11,000 endocrine operations have been submitted by BAETS members on surgery to the thyroid, parathyroid, adrenal and pancreas. Prior to the BAETS involvement with Dendrite the audit did not exist. A paper pilot was undertaken, designed by the members of the Executive committee (of the BAETS) that specified the data that the Association wished to be gathered. The BAETS engaged Dendrite to produce the first national audit report from paper-based data collection.
Dendrite proposed the implementation of their web-based registry system and this was commissioned two years ago "The very good news is that Members have taken to the web-based data entry system like ducks to water," he revealed. "It has been so successful that there are very few questions generated to the support staff."
This latest report covers the period from January 1st 2005 to December 31st 2006 and covers the four key surgical areas of endocrine disease; thyroid, parathyroid, adrenal and pancreatic surgery. The 144-page document examines existing surgical practice and reports on current clinical quality, which can be compared with standards set by national guidelines. The ability to record pathology also allows an examination of current surgical practice in benign and malignant disease, as well as participation in modern multidisciplinary management for thyroid cancer.
Key results from the Audit
Included in the publication are the outcomes from 3,804 thyroid operations (approximately one-fifth of the total number performed each year in the UK) submitted by over 70 BAETS members and the report highlights that there is a wide range of workload for thyroid disease. According to the Audit, some 22.5% of surgeons perform five or less thyroid operations per year. Another finding is that thyroid surgery is consultant-led in the main. In relation to clinical data and outcomes, the report records that thyroid malignancy accounted for 20% of all thyroid operations. No fewer than 80% of patients with thyroid cancer underwent pre-operative fine needle aspiration biopsy. Areas for improvement include the fact that only 79% cases of thyroid cancer were discussed at a multidisciplinary team meeting and that the rate of pre-operative vocal cord check for redo thyroid surgery was only 79%.
The analysis for parathyroid surgery includes data from 1,896 procedures submitted from over 50 BAETS members. Again, the reports notes that there was a wide range in workload, with 41% of surgeons performing less than ten cases each year. Like thyroid surgery, parathyroid surgery is consultant-led with evidence of supervised training in one-fifth of operations. The latest analysis has confirmed that BAETS members have embraced localisation studies; although the report highlights that there is some confusion about its role with regard to undertaking a targeted approach for those pathologies, which are themselves an indication for bilateral neck exploration. Overall, a third of operations were targeted. The overall success rate (normocalcaemia) was an impressive 95%. The data indicates that intraoperative qPTH assay and pre-operative localisation improved outcomes. The report also shows that the failure rate for multiple endocrine neoplasia was 20%. The overall mortality was 0.2%.
A total of 27 members submitted data from 317 adrenal operations, with 70% of cases undertaken by eight members and ten member performing two cases or less over a two-year period. Phaeochromocytoma, Cushing's and Conn's accounted for 72% of the pathology, with laparoscopic surgery reported as the most favoured approach, unless the tumour was malignant. The mortality was rate was reported as 0.7%.
In regard to pancreatic surgery insulinoma was found to be the most common pathology, with 70% of operations involving a laparotomy. Unfortunately, there was insufficient data to draw conclusions as only 24 cases were submitted by nine members. It is hoped that an increase in the data will provide more meaningful conclusions over time.
"We have had a fantastic response in terms of numbers of cases being submitted. I think this success in numbers we have is because the data we are collecting is not overcomplicated, but the huge numbers that we are accumulating make the data powerful. The report clearly shows that there is a wide variance in individual workload of members, particularly in the practice of surgery for thyroid cancer," added Mr Scott-Coombes. "The Audit also reveals that there are probably too many surgeons operating on rare diseases. The complication rates are higher than were expected, however this demonstrates honest data collection. Overall, there were good outcomes for parathyroid disease and the evidence clearly shows good training within thyroid and parathyroid surgery. Currently, the data for adrenal and pancreas surgery is still too small to draw many conclusions."
It is expected that in the future the dataset can be expanded to create greater clarity on additional issues. For example, distinguishing the primary thyroid pathology from any secondary diagnosis, establishing the indication for thyroid surgery and whether re-do thyroid pathology is performed on the same side as the previous operation. The web-based data entry system will allow a subtle increase in the complexity of the data collected.
This is the second such National Audit and although it has provided a wealth of data, according to Mr Scott-Coombes, there are still areas for improvements. "In order to get good compliance from our members the data that is collected has to be relatively uncomplicated. The feedback that we are giving to individual members is currently rather limited. We are working on a system that will give a more in-depth annual report for each member including comparisons with the National average. Although the Audit is currently anonymous, I think we may slowly lose the anonymity."
Moreover, the Audit currently collects data from members of the BAETS, despite much thyroid surgery being undertaken by non-members. "We have contacted other national organisations (ENT-UK [the British Association of Otorhinolaryngologists] and British Association of Head and Neck Oncologists [BAHNO]) to encourage those members who undertake thyroid surgery to contribute to the audit."
It is hoped that this latest report will be the catalyst for additional research projects as well and to stimulate debate among members that will result in improvements in service delivery, training and adherence to national guidelines. "The next Audit will report on 2006-2007 data. Much of this will be cumulative and will also include the data from the 2005-2006 audit. We will ask members to complete their data submission by April 2009 and hope to produce a report by September 2009. It is my hope that the large numbers of patients included will start to show trends with respect to workload and outcome," he added.
Mr Scott-Coombes also paid tribute to Dendrite: "I have enjoyed a close collaboration with Dendrite, a company that has a proven track-record in medical audit and who tailor the analyses in response to the clinical input. Not only has their support in writing the report has been magnificent, but their staff are both personable and knowledgeable in their field. I believe this type of audit will become more widespread amongst other specialties and I would have no hesitation in recommending Dendrite to other societies and associations."
Dr Peter Walton, Managing Director of Dendrite Clinical Systems, commented: "I would like to thank all the contributors for their efforts and in particular, Mr Scott-Coombes, for his unwavering enthusiasm and collaborative approach. This second national Audit clearly shows the value of national clinical audits. All healthcare systems have finite resources and such assessments can provide data on optimum provision of resources, especially in regard to current workloads and future training. We look forward to working to produce the third national audit with the BAETS in the future."
Press Contact: Owen Haskins