Kelvin Memeh MD, MS, MBA

The association of Neuromonitoring during thyroidectomy and the risk of recurrent laryngeal nerve injury remains controversial. Hopefully we moved the debate forward with our recent study just published in @AnnalsofSurgery pubmed.ncbi.nlm.nih.gov/35837957/

@cchildersmd Even beyond abdominal surgery, we are seeing prolonged OR time in neck operation. We published a paper last year on obesity’s association with prolonged OR time ( amongst other outcomes) during thyroidectomy. doi.org/10.1002/wjs.12… It’s time incentivize healthy weight!

Moving forward, we think this justifies either a. a new obesity modifier or b. a series of add-on codes that could be used to accurately reimburse surgeons for the added work of taking care of this growing population.

Latest manuscript is out now @acsJACS journals.lww.com/journalacs/abs… We showed that increasing weight class is consistently associated with increased physician work across a broad array of common abdominal operations. It begs the question - is it time for an obesity modifier?

Excited that @DrMemeh will be joining #THE @OhioStateSurg as an assistant professor of #Surgery in the Division of Surgical Oncology. Having completed an endocrine fellowship @uchicagosurgery he will join our #endocrine 🦏 TEAM! Welcome to #BuckeyeNation! ⭕️🙌

@PhysiciansFound @BrandeisU I am still waiting for the code to apply

The Physicians Foundation’s Leadership Institute at @BrandeisU offers a unique opportunity for practicing #physicians to deepen their understanding of health drivers and influence policy decisions. All costs covered. Apply by November 30: physiciansfoundation.org/brandeis-leade…

Congratulations @DrMemeh on an excellent presentation of our study examining thyroidectomy-specific outcomes and BMI across multiple modeling approaches at this year’s @IAESurgeons meeting in Kuala Lumpur! #isw2024kualalumpur #isw2024 #endocrinesurgery #UMiami

Congrats @DrMemeh! Examining VSD after thyroidectomy showed no differences for rates of post op hematoma or hypocalcemia & higher rates of voice hoarseness and longer OR time. Thank you @VAsurgeons for highlighting the study! @FiemuNwariaku #AVAS2023

Elderly man jumps on public piano and has everyone amazed 🙌

@cchildersmd @ZainHashmiMD @JAMASurgery Agreed 100%. Also, we should think of "triangulation" studies. As in triangulating the evidence, using a different study design/statistical method with the same or different database, if possible. Especially important for studies with results that can potentially change practice

@ZainHashmiMD @JAMASurgery As many as possible IMO, especially in commonly used databases (HCUP, NSQIP). I see no reason for a study that uses national NSQIP data not to be replicated these days given how "easy" it is to analyze the data. Research should always fall back to the null hypothesis.

Out today in @JAMASurgery we introduce the concept of replication studies for database research. Would love to hear people’s thoughts. ja.ma/2WLXxk0

Thank you, @doctrjp1(Jesse Pasternak), for the focus review of our paper in the Sept edition of @clinicalthyroid. While neuromonitoring should not replace good surgical skills, evidence suggests it helps reduce nerve injury rates. @TheAACE @TheAAES liebertpub.com/doi/full/10.10…

Great work by our resident Dr. Bailey Humphries @UTKnoxSurgery & my colleague @DrMemeh! Thank you @SWexner & @SurgJournal for publishing our work examining Prognostic Factors and Survival for Hurthle Cell Carcinoma!

@BeninatoToni @AnnalsofSurgery Oh good! I perhaps misunderstood your question. Happy to connect via DM where there is no restrictions on number of characters. Thanks for engagement on here, I appreciate it.

@DrMemeh @AnnalsofSurgery As a former NSQIP Surgeon Champion, I am very clear on how the data collection works. I think you are misunderstanding my point. Congrats on the paper!

The association of Neuromonitoring during thyroidectomy and the risk of recurrent laryngeal nerve injury remains controversial. Hopefully we moved the debate forward with our recent study just published in @AnnalsofSurgery pubmed.ncbi.nlm.nih.gov/35837957/

@BeninatoToni @AnnalsofSurgery Also a good number of high-volume surgeons do not use IONM - I met a good number of them at the ASA lol. But to your point, adjusting for case volume would be very helpful, and that’s we also applied the E-value method to assess for unmeasured confouding in the paper.

@DrMemeh @AnnalsofSurgery I'm not sure how these FAQ answer my question. NSQIP sites have to choose which procedure targeted datasets to participate in. A low volume thyroid center probably would not choose to participate in the thyroid specific dataset because they would not get meaningful data from it.

@BeninatoToni @AnnalsofSurgery No, not according to the NSQIP ACS. In short, they intentionally employ random sampling to ensure that hospitals with small case volumes are well-represented in the dataset. You can read more here: facs.org/quality-progra…

@DrMemeh @AnnalsofSurgery But one probably would be high volume to decide to participate in the thyroidectomy specific database and that's the only place that records IONM use I believe

@ButterflyThyro That’s good to know!

@DrMemeh Thank you so much ,22 years ago now ,I had no voice initially for 5 months but the cord is lying mid line so voice quality much better 🦋

I have a permanent vocal cord palsy 🦋

@BeninatoToni @AnnalsofSurgery Great question! The NSQIP dataset documented IONM in 70% of cases. And we know l,from other studies,that only 25-40% of thyroidectomies in the US are performed by high-volume surgeons. So, I think we can safely infer that IONM is likely surgeon’s preference rather than volume.

@DrMemeh @AnnalsofSurgery Is IONM just a marker of a high volume surgeon in NSQIP? That's always bothered me about this data.

@Tfeend @BeninatoToni @AnnalsofSurgery Yea, but that’s been the issue. An outcome probability that low will require a large number if patients to show an meaningful difference. We evaluated 24K + patients in the dataset. There might be another way to approximate an RCT - the causal inference methodology. Game?

@BeninatoToni @DrMemeh @AnnalsofSurgery Seems like this could be randomized and evaluated that way.

@KTinsleyA @AnnalsofSurgery Good eye Tinsley! Yes, the “rare outcome” statement mostly refers to the historically quoted RLN injury rates of 1-2%. However, statistically speaking, though subject to debate, a rare outcome is that with an event probability of 0.05 . So, 0.06 ain’t that far off either 🤷🏾‍♂️😄

@DrMemeh @AnnalsofSurgery Would love to read full article but already surprised by 6.2% rate of RLN injury and that it is called a rare outcome.

@FeibiZheng @KTinsleyA @AnnalsofSurgery Also, I think that the current quoted rate of 1-2% for RLN injury only applies to high-volume surgeons. This NSQIP data is probably closer to the real rate given that only 25% of thyroid surgery are performed by high volume thyroid surgeons 🤷🏾‍♂️

@KTinsleyA @DrMemeh @AnnalsofSurgery NSQIP has a very liberal definition of nerve injury. That’s one of the reasons the rate is high in this dataset.

@FeibiZheng @KTinsleyA @AnnalsofSurgery That is true! it’s quite possible that not every voice hoarseness reported in the NSQIP resulted from RLN injury. However, there is no reason to believe it would be reported more in one group compared to the other. We addressed this in the paper.