Complications Decrease with Surgeon Experience in Thyroidectomy
Among patients undergoing the surgical removal of their thyroid, complications associated with the procedure are drastically reduced if surgeons perform a larger number of the surgeries per year. These results were recently published in the Annals of Surgery.
The thyroid is a small, butterfly-shaped gland that is located at the base of the neck. It weighs less than one ounce, but is important in several bodily functions. The thyroid produces hormones that are associated with the rate in which cells metabolize fats and carbohydrates, as well as regulation of body temperature, heart rate, calcium levels in the blood, and protein production.
There are different types of thyroid cancer, depending upon which cells within the thyroid the cancer develops. One type of treatment that is common among all types of thyroid cancer is the surgical removal of the cancer, which can include removal of the entire thyroid, the majority of the thyroid, or a lobe of the thyroid gland.
Researchers recently evaluated data in an attempt to determine if the volume of thyroidectomies performed by a surgeon per year had an influence on the risk of complications from the procedure.
The study included 16,954 patients identified from the Health Care Utilization Project-National Inpatient Sample from 1998-2009 who underwent a total thyroidectomy (surgical removal of the entire thyroid gland). Nearly half of the patients had thyroid cancer.
- Overall, the risk of a patient experiencing a complication associated with a thyroidectomy decreased significantly if their surgeon performed larger numbers of the procedure every year.
- Patients treated by a surgeon who performed only one thyroidectomy per year had an 87% increase in the odds of experiencing a complication associated with the procedure, compared with only a 3% increase in odds for those whose surgeon performed between 21-25 thyroidectomies per year.
- The increase in odds of experiencing a complication increased by 68% for patients whose surgeon performed between 2-5 thyroidectomies per year; 42% for patients whose surgeon performed between 6-10 thyroidectomies per year; 22% for patients whose surgeon performed between 11-15 thyroidectomies per year; and 10% for patients whose surgeon performed between 16-20 thyroidectomies per year.
- The length of hospital stays following surgery was also reduced for patients whose surgeons performed a larger number of thyroidectomies per year.
The authors concluded that “This is the first study to identify a surgeon volume threshold (>25 total thyroidectomies/y) that is associated with improved patient outcomes. Identifying a threshold number of cases defining a high-volume thyroid surgeon is important, as it has implications for quality improvement, criteria for referral and reimbursement, and surgical education.”
These results are consistent with other studies indicating that patients treated by surgeons who perform a higher volume of specific surgical procedures per year tend to have improved outcomes, compared to those treated by surgeons who perform a smaller number of the procedure per year.
Reference: Adam A, Thomas S, Youngwirth L, et al. Is There a Minimum Number of Thyroidectomies a Surgeon Should Perform to Optimize Patient Outcomes? Annals of Surgery. Available March 8, 2016 on-line. doi: 10.1097/SLA.0000000000001688. Accessed March 23, 2016. Available at: http://journals.lww.com/annalsofsurgery/Abstract/publishahead/Is_There_a_Minimum_Number_of_Thyroidectomies_a.97012.aspx.
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