Assessment of compliance with 298 operative notes of thyroidectomies in Yaoundé: are there any medico-legal implications for surgeons?

Abstract

Introduction: Complications following thyroidectomy are increasingly leading to surgeons facing legal action, with the outcome often relying on the quality of expert operative reports. Our objective was to evaluate the compliance of operative notes (ONs) of thyroidectomies performed in Yaoundé, in order to understand the medico legal implications.

Material and methods: We compared 298 thyroidectomy ONs with the recommendations of the Royal College of Surgeons of England. General data, compliance scores, and references to elements of medico-legal importance were collected and analyzed. We performed chi-square tests, applied logistic regression to identify predictors of unfavourable ONs in cases of litigation against the surgeon, and set p < 0.05 as the threshold for statistical significance.

Results: The compliance score was 57.65 ± 9.8. Of the 298 ONs, 250 (84%) were non-compliant, 238 (80%) made no mention of the parathyroid glands, and none mentioned the use of nerve monitoring. 116 ONs (39%) were unfavourable, with those written by the lead surgeon being three times more likely to be unfavourable than those written by the assistant or resident (p = 0.000). The type of healthcare facility, the indication for surgery, the tumour cytology/topography, and the date of writing did not predict the unfavourable nature of the ONs.
Conclusion: A high proportion of the ONs studied were non-compliant, omitting information that could engage the liability of surgeons in the event of disputes and justifying urgent awareness raising.