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Is There a Minimum Number of Thyroidectomies a Surgeon Should Perform to Optimize Patient Outcomes?

Publication ,  Journal Article
Adam, MA; Thomas, S; Youngwirth, L; Hyslop, T; Reed, SD; Scheri, RP; Roman, SA; Sosa, JA
Published in: Ann Surg
February 2017

OBJECTIVE: To determine the number of total thyroidectomies per surgeon per year associated with the lowest risk of complications. BACKGROUND: The surgeon volume-outcome association has been established for thyroidectomy; however, a threshold number of cases defining a "high-volume" surgeon remains unclear. METHODS: Adults undergoing total thyroidectomy were identified from the Health Care Utilization Project-National Inpatient Sample (1998-2009). Multivariate logistic regression with restricted cubic splines was utilized to examine the association between the number of annual total thyroidectomies per surgeon and risk of complications. RESULTS: Among 16,954 patients undergoing total thyroidectomy, 47% had thyroid cancer and 53% benign disease. Median annual surgeon volume was 7 cases; 51% of surgeons performed 1 case/y. Overall, 6% of the patients experienced complications. After adjustment, the likelihood of experiencing a complication decreased with increasing surgeon volume up to 26 cases/y (P < 0.01). Among all patients, 81% had surgery by low-volume surgeons (≤25 cases/y). With adjustment, patients undergoing surgery by low-volume surgeons were more likely to experience complications (odds ratio 1.51, P = 0.002) and longer hospital stays (+12%, P = 0.006). Patients had an 87% increase in the odds of having a complication if the surgeon performed 1 case/y, 68% for 2 to 5 cases/y, 42% for 6 to 10 cases/y, 22% for 11 to 15 cases/y, 10% for 16 to 20 cases/y, and 3% for 21 to 25 cases/y. CONCLUSIONS: 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.

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Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

February 2017

Volume

265

Issue

2

Start / End Page

402 / 407

Location

United States

Related Subject Headings

  • Thyroidectomy
  • Surgery
  • Retrospective Studies
  • Postoperative Complications
  • Outcome Assessment, Health Care
  • Middle Aged
  • Male
  • Logistic Models
  • Learning Curve
  • Incidence
 

Citation

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Adam, M. A., Thomas, S., Youngwirth, L., Hyslop, T., Reed, S. D., Scheri, R. P., … Sosa, J. A. (2017). Is There a Minimum Number of Thyroidectomies a Surgeon Should Perform to Optimize Patient Outcomes? Ann Surg, 265(2), 402–407. https://doi.org/10.1097/SLA.0000000000001688
Adam, Mohamed Abdelgadir, Samantha Thomas, Linda Youngwirth, Terry Hyslop, Shelby D. Reed, Randall P. Scheri, Sanziana A. Roman, and Julie A. Sosa. “Is There a Minimum Number of Thyroidectomies a Surgeon Should Perform to Optimize Patient Outcomes?Ann Surg 265, no. 2 (February 2017): 402–7. https://doi.org/10.1097/SLA.0000000000001688.
Adam MA, Thomas S, Youngwirth L, Hyslop T, Reed SD, Scheri RP, et al. Is There a Minimum Number of Thyroidectomies a Surgeon Should Perform to Optimize Patient Outcomes? Ann Surg. 2017 Feb;265(2):402–7.
Adam, Mohamed Abdelgadir, et al. “Is There a Minimum Number of Thyroidectomies a Surgeon Should Perform to Optimize Patient Outcomes?Ann Surg, vol. 265, no. 2, Feb. 2017, pp. 402–07. Pubmed, doi:10.1097/SLA.0000000000001688.
Adam MA, Thomas S, Youngwirth L, Hyslop T, Reed SD, Scheri RP, Roman SA, Sosa JA. Is There a Minimum Number of Thyroidectomies a Surgeon Should Perform to Optimize Patient Outcomes? Ann Surg. 2017 Feb;265(2):402–407.

Published In

Ann Surg

DOI

EISSN

1528-1140

Publication Date

February 2017

Volume

265

Issue

2

Start / End Page

402 / 407

Location

United States

Related Subject Headings

  • Thyroidectomy
  • Surgery
  • Retrospective Studies
  • Postoperative Complications
  • Outcome Assessment, Health Care
  • Middle Aged
  • Male
  • Logistic Models
  • Learning Curve
  • Incidence