Malpractice litigation after thyroid surgery: The role of recurrent laryngeal nerve injuries, 1989-2009 DISCUSSION

Background. Recurrent laryngeal nerve injuries remain a complication that is a source of concern to both surgeons and patients. RLN monitoring has gained popularity in recent years despite a lack of evidence showing decreased rates of recurrent laryngeal nerve injury when nerve monitoring is used. We sought to explore malpractice litigation in thyroid surgery with respect to recurrent laryngeal nerve monitoring. With increased public awareness and surgeon use of recurrent laryngeal nerve monitoring, we hypothesize an increase in its use in malpractice litigation in the area of thyroid surgery. Methods. Using the LexisNexis Academic legal database, a retrospective review of all relevant federal and state cases from 1989 to 2009 was performed using the search terms "thyroid," "surgery," and "medical malpractice." From this search, data were compiled including year and state of the court's decision, the outcome of the trial, the type of complication, any mention of recurrent laryngeal nerve monitoring, and the specialty of the surgeon who performed the procedure. The cases that were settled out of court were not included in this analysis. Results. A total of 143 medical malpractice cases involving thyroid surgery were retrieved from our search from 1989 to 2009. After reviewing all cases, 33 cases in which the alleged negligence occurred after thyroid surgery were used for analysis. Of these cases, 15 involved recurrent laryngeal nerve injury; interestingly, no mention of recurrent laryngeal nerve monitoring was noted in any of the cases. Conclusion. Although recurrent laryngeal nerve monitoring has become more widely available and used, there is no evidence that its use or nonuse has played a role in malpractice litigation in the last 20 years. recurrent laryngeal nerve injury remains a cause of malpractice litigation. (Surgery 2010; 148:718-23.)