Prevalence and patterns of intraoperative nerve monitoring for thyroidectomy

Objective: To estimate the patterns of use of intraoperative recurrent laryngeal nerve (RLN)-monitoring devices during thyroid surgery by otolaryngologists in the United States. Methods: A questionnaire was mailed to 1685 randomly selected otolaryngologists, representing approximately half of all otolaryngologists currently practicing in the United States. Topics covered included training history and current practice setting, use and characteristics of use of RLN monitoring during thyroid surgery, as well as history of RLN injury and/or subsequent lawsuits. χ² test was used to examine associations between monitor usage and dependent variables, and odds ratios calculated by logistic regression were used to refine the magnitude of these associations. Results: A total of 685 (40.7%) of questionnaires were returned, and 81 percent (555) of respondents reported performing thyroidectomy. Of those, only 28.6 percent (159) reported using intraoperative monitoring for all cases. Respondents were 3.14 times more likely to currently use intraoperative monitoring if they used it during their training. Surgeons currently using intraoperative RLN monitoring during thyroidectomy were 41 percent less likely to report a history of permanent RLN injury. Further information about surgeon background and rationale for decisions regarding RLN monitor usage are discussed. Conclusions: Presently, the majority of otolaryngologists in the United States do not report regular usage of RLN monitoring in their practices. Surgeon background and training, more so than surgical volume, significantly influenced the use of intraoperative RLN monitoring.