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Francis D. Moore Jr, MD

Arch Surg. 2009;144(5):406.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

This excellent analysis from the innovative group at Yale confirms a personal bias of mine from about 20 years of practice: pregnant patients requiring endocrine surgery of the neck should be treated with caution, perhaps deferring thyroid cancer surgery until after delivery (or performing lobectomy only during the second trimester) under the supervision of a team of experienced clinicians. This caution is being exercised in practice because pregnant patients more commonly receive care at large urban institutions with high-risk obstetrics.

These conclusions reinforce the perhaps mistaken notion that the surgeon or the institution controls the outcome. For instance in Table 3, we see nearly identical rates of maternal and fetal morbidity following surgery, suggesting that maternal complications (largely surgeon-controlled) produce fetal complications. Yet when analyzed by region, we see a 7.1% fetal complication rate in the Northeast with a 0% maternal complication rate. This type . . . [Full Text of this Article]

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