Effect of surgeons’ annual operative volume on the risk of permanent Hypoparathyroidism, recurrent laryngeal nerve palsy and Haematoma following thyroidectomy: analysis of United Kingdom registry of endocrine and thyroid surgery (UKRETS)

Aspinall, Sebastian; Oweis, Deyana; Chadwick, David

doi:10.1007/s00423-019-01798-7

Cited by 51 publications

(33 citation statements)

References 26 publications

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“…Furthermore, complications are greater within "low-volume" centers and justify the use of lobectomy as the optimal choice for most low-risk WDTC patients. 75,76 It is important to note that the resources for determining the criteria for risk analysis may not be uniformly available worldwide. Under such circumstances, modifications are necessary to ensure optimal care.…”

Section: Discussionmentioning

confidence: 99%

“…It should be noted that most patients who receive thyroidectomy for WDTC are treated by “low‐volume” surgeons performing less than 25 cases per year and are less likely to have multidisciplinary team involvement. Furthermore, complications are greater within “low‐volume” centers and justify the use of lobectomy as the optimal choice for most low‐risk WDTC patients 75,76 …”

Section: Discussionmentioning

confidence: 99%

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Case for staged thyroidectomy

et al. 2020

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Recent modifications in the management of well‐differentiated thyroid cancer have resulted in significant alterations in clinical approach. Utilizing a series of preoperative and postoperative risk factors involving both the patient and the disease pathology, we offer the term “staged thyroidectomy” to help organize these risk factors for patients and the endocrine team to optimize management. This approach is intended to incorporate our latest nuanced understanding of certain endocrine pathology and may serve to optimize patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Case for staged thyroidectomy

et al. 2020

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“…For a number of operations an association between volume and outcome has been demonstrated. For operations in which the individual technical competence and the experience of the surgeon presumably play a large role, such as thyroid, hernia or carotid surgery, the outcome is associated with the volume per surgeon [16,17]. For these operations, severe complications are relatively infrequent and mortality is low.…”

Section: Discussionmentioning

confidence: 99%

Association between operation volume and postoperative mortality in the elective open repair of infrarenal abdominal aortic aneurysms: systematic review

et al. 2020

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Background An inverse association between the case volume per hospital and surgeon and perioperative mortality has been shown for many surgical interventions. There are numerous studies on this issue for the open treatment of infrarenal aortic aneurysms. Aim To present the available data on the association between the case volume per hospital and surgeon and perioperative mortality in the elective open repair of infrarenal aortic aneurysms in a systematic review. Materials and methods Using the PubMed, Cochrane Library, Web of Science Core Collection, CINAHL, Current Contents Medicine (CCMed), and ClinicalTrials.gov databases, a systematic search was performed using defined keywords. From the search results, all original papers were included that compared the elective open repair of an infrarenal aortic aneurysm in a “high volume” center with a “low volume” center or by a “high volume” surgeon with a “low volume” surgeon, as defined in the respective study. Results After deduplication, the literature search yielded 1021 hits of which 60 publications met the inclusion criteria. Of these, 37/43 studies showed a lower mortality in “high volume” compared to “low volume” centers and 14/17 comparisons showed a lower mortality for “high volume” compared to “low volume” surgeons. The effect measures, usually odds ratios, ranged from 0.37 to 0.99 for volume per hospital and 0.31 to 0.92 for volume per surgeon. Regarding the threshold values for the definition of “high volume” and “low volume,” a clear heterogeneity was shown between the individual studies. Discussion The available data on the association between the case volume per hospital and surgeon and perioperative mortality in the elective open repair of infrarenal aortic aneurysms show that interventions performed in “high volume” centers or by “high volume” surgeons are associated with lower mortality. To ensure the best possible outcome in terms of low perioperative mortality in the open repair of infrarenal aortic aneurysms, the aim should be centralization with high case volume per hospital and surgeon.

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“…The consecutive sensitivity analysis demonstrated that total thyroidectomy apparently only becomes a cost-effective strategy if the risk of stages III and IV PTC is 82.4% among patients with Bethesda V cytology on preoperative FNA. These counterintuitive findings may be related to the quantification of the risk of morbidity (hypothyroidism, hypoparathyroidism, or unilateral RLN injury) after lobectomy was estimated at up to 50% which is high compared to national registry data [ 49 ]. Whether the true cost of follow-up and additional imaging rather than a cheaper nurse led thyroglobulin follow-up have been contemplated was not clearly stated.…”

Section: Surgery As the Solution?mentioning

confidence: 99%

Differentiated Thyroid Cancer: A Health Economic Review

Heede

Tolley

Marco

et al. 2021

Cancers

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The incidence of differentiated thyroid cancer (DTC) is rising, mainly because of an increased detection of asymptomatic thyroid nodularity revealed by the liberal use of thyroid ultrasound. This review aims to reflect on the health economic considerations associated with the increasing diagnosis and treatment of DTC. Overdiagnosis and the resulting overtreatment have led to more surgical procedures, increasing health care and patients’ costs, and a large pool of community-dwelling thyroid cancer follow-up patients. Additionally, the cost of thyroid surgery seems to increase year on year even when inflation is taken into account. The increased healthcare costs and spending have placed significant pressure to identify potential factors associated with these increased costs. Some truly ground-breaking work in health economics has been undertaken, but more cost-effectiveness studies and micro-cost analyses are required to evaluate expenses and guide future solutions.

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Effect of surgeons’ annual operative volume on the risk of permanent Hypoparathyroidism, recurrent laryngeal nerve palsy and Haematoma following thyroidectomy: analysis of United Kingdom registry of endocrine and thyroid surgery (UKRETS)

Cited by 51 publications

References 26 publications

Case for staged thyroidectomy

Case for staged thyroidectomy

Association between operation volume and postoperative mortality in the elective open repair of infrarenal abdominal aortic aneurysms: systematic review

Differentiated Thyroid Cancer: A Health Economic Review

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