(0255) Systematic Review and Appraisal of Clinical Practice Guidelines on Intraoperative Nerve Monitoring in Thyroid/Parathyroid Surgery

Introduction: Developments in intraoperative nerve monitoring (IONM) have led to the creation of clinical practice guidelines for these techniques. We assessed the quality and rigor of existing guidelines for IONM in thyroid and parathyroid surgery through the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.

Methods: A systematic review was performed using the MEDLINE (via PubMed), EMBASE, and SCOPUS databases from database initiation through October 2023 for clinical practice guidelines, recommendations, and consensus statements on IONM in thyroid/parathyroid surgery. Guidelines were evaluated by 4 independent reviewers via the AGREE II instrument. Scaled domain scores were calculated, with a threshold of >60% indicating satisfactory quality. Intraclass correlation coefficients (ICC) were calculated to assess reliability between reviewers.

Results: Eight guidelines met inclusion criteria. The average overall scaled domain score across all guidelines was 68.03±5.87%. Three recommendation statements scored >60% in 5 domains, classified as “high” quality. Four articles scored >60% in 3-4 domains, indicating “average” quality, and one article scored >60% in only 2 domains, indicating “low” quality. The highest-scoring domains across all guidelines were ‘Scope and Purpose’ (95.49±5.24%) and ‘Clarity of Presentation’ (86.81±5.94%) while the lowest scoring domains were ‘Applicability’ (29.43±5.81%) and ‘Rigor of Development’ (58.72±12.95%). The AAO-HNS Cranial Nerve Monitoring Task Force guideline received the highest average domain score (75.78±22.45%). All guidelines lacked information about protocols for updating guidelines. Average ICC across all domains was 0.842, indicating good interrater reliability.

Conclusions: The quality of clinical practice guidelines for IONM in thyroid and parathyroid surgery is varied overall, but high quality guidelines do exist. Future guidelines could benefit by clearly describing the methodology for updating guideline recommendations and by addressing barriers to clinical implementation and adherence.