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Thyroidectomy complications less likely for high-volume surgeons
Patients undergoing thyroidectomy who use high-volume surgeons — those performing more than 25 procedures per year — have better outcomes, according to a retrospective review of hospital discharge data.
“This is a very technical operation, and patients should feel empowered to ask their surgeons how many procedures they do each year, on average,” Julie A. Sosa, MD, chief of endocrine surgery at Duke Medical Center in Durham, North Carolina, said in a press release. “Surgeons have an ethical responsibility to report their case numbers. While this is not a guarantee of a positive patient outcome, choosing a more experienced surgeon certainly can improve the odds that the patient will do well.”
Julia A. Sosa
Sosa and colleagues evaluated data from the Health Care Utilization Project–National Inpatient Sample (1998-2009) on 16,954 adults undergoing total thyroidectomy to determine the link between complications and the number of thyroidectomies performed by a surgeon per year. Thyroid cancer was the most frequent indication for thyroidectomy (47%).
Among 4,627 surgeons, the range of annual surgeon volume was one to 157 cases, with a median of seven cases. After total thyroidectomy, 6% of patients experienced at least one complication; 2% experienced hypoparathyroidism or a recurrent laryngeal nerve injury. A decreasing likelihood of a postoperative complication was linked to increasing annual surgeon procedural volume up to an inflection point of 25 cases per year after adjustment for patient demographic and clinicopathologic characteristics and hospital type and volume (P < .001), suggesting that a surgeon volume threshold of more than 25 cases per year is associated with significantly improved patient outcome.
Patients were divided into groups based on surgeon volume: high volume (> 25 cases per year; n = 3,180) or low volume (≤ 25 cases per year; n = 13,774).
Eighty-one percent of all patients underwent total thyroidectomy by a low-volume surgeon, and 51% of them performed one procedure per year.
Compared with patients who underwent surgery by a high-volume surgeon, those who underwent surgery by a low-volume surgeon were more likely to experience endocrine-related complications (P = .01), bleeding (P = .006), respiratory complications (P = .0002) or any complication (P < .0001). Patients treated by low-volume surgeons also had longer hospital stay (P < .0001) and higher cost for surgical care (P < .0001).
Patients treated by low-volume surgeons were 87% more likely to have complications if the surgeon performed one case per year, 68% more likely for two to five cases per year, 42% more likely for six to 10 cases, 22% for 11 to 15 cases, 10% for 16 to 20 cases and 3% for 21 to 25 cases vs. patients treated by high-volume surgeons.
“The take-home message for referring providers such as endocrinologists, internists, family practice physicians and oncologists is that they should direct patients with thyroid disease or thyroid cancer that requires total thyroidectomy to surgeons who perform > 25 cases per year in order to increase the changes that patients will have a superior outcome,” Sosa told Endocrine Today. “If such a surgeon is not available, then the surgeon with the next highest volume should see the patients in order to mitigate risk. In practices where several surgeons perform thyroidectomy but none do > 25 cases per year, referrals should be redirected such that the minimum volume threshold is achieved by a subset of the surgeons.” – by Amber Cox
For more information:
Julie A. Sosa, MD, MA, can be reached at Duke University Medical Center #2945, Durham, NC 27710; email: Julie.sosa@duke.edu.
Disclosure: The researchers report no relevant financial disclosures.