Associations of Volume and Thyroidectomy Outcomes

Liang, Tsung–Jung; Liu, Shiuh–Inn; Mok, King-Tong; Shi, Hon-Yi

doi:10.1177/0194599816634627

Cited by 60 publications

(36 citation statements)

References 43 publications

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“…In contrast, a recent study showed that although larger surgeon volumes were associated with lower rates of vocal cord palsy and hypoparathyroidism, the absolute effect of volume on outcomes was modest, especially in hospitals with low complication rates [ 9 ]. Although the evidence for a volume-outcome relationship in thyroidectomy appears strong, other confounding surgeon and hospital-specific factors may also play an important role [ 10 ]. Nevertheless, the American Thyroid Association and the American Association of Endocrine Surgeons both recommend that thyroidectomy should be performed by high-volume surgeons where possible, defined as a minimum of 20 thyroidectomies annually [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

The volume and outcome relationship for thyroidectomy in England

Gray¹,

Aspinall

Tolley

et al. 2021

Langenbecks Arch Surg

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Purpose The delivery of surgical care in England has seen a momentum towards centralisation within larger volume hospitals and surgical teams. The aim of this study was to investigate outcomes in England in relationship to hospital and surgeon annual volumes for total thyroidectomy. Methods Data were extracted from the Hospital Episodes Statistics (HES) database for England. A 6-year period (April 2012–March 2018 inclusive) for all adult admissions for thyroidectomy was used in the analysis. The primary outcome measure used was a length of hospital stay greater than 2 days or an emergency readmission within 30 days following surgery. This was used as a proxy for surgical complications. A multilevel modelling strategy was used to adjust for hierarchy and potentially confounding. Results Data for 22,823 total thyroidectomies across 144 hospital trusts were used for analysis. For total thyroidectomy, larger volume surgeons had reduced levels of post-surgical complications; length of stay > 2 and > 4 days; emergency readmission at 30 days; and hypoparathyroidism, vocal cord palsy, stridor, and tracheostomy at 1-year post-surgery. Larger hospital volume was associated with lower levels of emergency readmission at 30 days and hypoparathyroidism at 1 year. Conclusions There is significant correlation between surgeon volume and clinical outcome for total thyroidectomy. The relationship was approximately linear, and a low-volume threshold could not be defined. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-021-02223-8.

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Section: Introductionmentioning

confidence: 99%

The volume and outcome relationship for thyroidectomy in England

Gray¹,

Aspinall

Tolley

et al. 2021

Langenbecks Arch Surg

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“…However, different volume groups had similar in-hospital mortality rates. Unfortunately, morbidity was out of the scope of this study [ 12 ] (ELIII, RGC).…”

Section: Resultsmentioning

confidence: 99%

Volume, outcomes, and quality standards in thyroid surgery: an evidence-based analysis—European Society of Endocrine Surgeons (ESES) positional statement

Lorenz

Raffaelli

Barczyński

et al. 2020

Langenbecks Arch Surg

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Introduction Continuous efforts in surgical speciality aim to improve outcome. Therefore, correlation of volume and outcome, developing subspecialization, and identification of reliable parameters to identify and measure quality in surgery gain increasing attention in the surgical community as well as in public health care systems, and by health care providers. The need to investigate these correlations in the area of endocrine surgery was identified by ESES, and thyroid surgery was chosen for this analysis of the prevalent literature with regard to outcome and volume. Materials and methods A literature search that is detailed below about correlation between volume and outcome in thyroid surgery was performed and assessed from an evidence-based perspective. Following presentation and live data discussion, a revised final positional statement was presented and consented by the ESES assembly. Results There is a lack of prospective randomized controlled studies for all items representing quality parameters of thyroid surgery using uniform definitions. Therefore, evidence levels are low and recommendation grades are based mainly on expert and peer evaluation of the prevalent data. Conclusion In thyroid surgery a volume and outcome relationship exists with respect to the prevalence of complications. Besides volume, cumulative experience is expected to improve outcomes. In accordance with global data, a case load of < 25 thyroidectomies per surgeon per year appears to identify a low-volume surgeon, while > 50 thyroidectomies per surgeon per year identify a high-volume surgeon. A center with a case load of > 100 thyroidectomies per year is considered high-volume. Thyroid cancer and autoimmune thyroid disease predict an increased risk of surgical morbidity and should be operated by high-volume surgeons. Oncological results of thyroid cancer surgery are significantly better when performed by high-volume surgeons.

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“…All studies agree that operations performed by experienced surgeons and in high volume centers (> 100 thyroidectomies / year) show a lower complication rate and a shorter hospital stay. (8) In particular, it has been shown that the length of stay and complications are more determined by the surgeon experience than by hospital volume, which does not have a consistent association with the results. 3Some study described also a threshold (> 25 total thyroidectomies/y) that identify a high-volume thyroid surgeon and it is associated with improved patient outcomes.…”

Section: Discussionmentioning

confidence: 89%

Adverse Events in Thyroid Surgery. Observational Study in Three Surgical Units With High Volume/Year.

Río¹,

Carcoforo

Medas

et al. 2020

Preprint

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Background Thyroid surgery, performed for benign or malignant pathologies, is one of the most frequently performed procedures and its frequency has even been increasing in recent years. Postoperative bleeding, recurrent laryngeal nerve (RLN) palsy, associated to dysphonia, dysphagia, dyspnea, and hypoparathyroidism represent the most fearful and common complications. We conducted a multicenter, observational study of retrospectively collected data in three high-volume referral centers, enrolling all patients undergone to thyroid surgery between January 2016 and December 2017 in Parma University Hospital, Cagliari University Hospital and Ferrara University Hospital.Materials Patients were divided into 5 groups, differentiated thyroid carcinoma, medullary thyroid carcinoma, non-toxic benign pathology, hyperfunctioning benign pathology and NIFTP (Non-invasive Follicular Thyroid neoplasm with Papillary-like nuclear features). A follow up at 7 and 30 days was executed, evaluating the onset of paresthesia, dysphonia and dysphagia. A six-month follow-up was conducted in cases of early complications.Results Totally, 1252 patients were eligible for the study: 907 female and 345 male, with a female to male ratio of 2.6:1 and an average age of 53.428. Total thyroidectomy was performed in 1022 cases, lobectomy in 230.After 6 months we recorded paresthesia in 0.5%, dysphonia in 1.8% and dysphagia in 0.5%.Conclusion Our study confirms once again that a share of morbidity escapes the possibilities of prediction and control by the operator, depending on patient anamnestic, pathological or anatomical factors.

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Associations of Volume and Thyroidectomy Outcomes

Cited by 60 publications

References 43 publications

The volume and outcome relationship for thyroidectomy in England

The volume and outcome relationship for thyroidectomy in England

Volume, outcomes, and quality standards in thyroid surgery: an evidence-based analysis—European Society of Endocrine Surgeons (ESES) positional statement

Adverse Events in Thyroid Surgery. Observational Study in Three Surgical Units With High Volume/Year.

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