Surgeon volume and adequacy of thyroidectomy for differentiated thyroid cancer

Adkisson, Cameron D.; Howell, Gina M.; McCoy, Kelly L.; Armstrong, Michaele J.; Kelley, Meghan L.; Stang, Michael T.; Joyce, Judith M.; Hodak, Steven P.; Carty, Sally E.; Yip, Linwah

doi:10.1016/j.surg.2014.08.024

Cited by 48 publications

(38 citation statements)

References 21 publications

(35 reference statements)

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“…(9–14, 16) We found that patient preference was the most common reason physicians cited that would decrease likelihood of referral of older thyroid cancer patients to a high-volume surgeon. This highlights the vital role of the patient in the shared decision-making process and the influence of patient preference on physicians’ treatment recommendations.…”

Section: Discussionmentioning

confidence: 97%

“…(24–26) Older individuals with comorbidities are also at risk for functional disabilities, which can further impact cancer treatment strategies. (27) Additionally, several prior studies have shown that high surgeon volume is a significant predictor of improved outcomes following thyroidectomy, and has been associated with more completeness of initial operation (14, 15), shorter length of hospital stay, lower postoperative complication rates and lower costs. (9–14, 16) The lowest postoperative complication rates have been shown to be achieved by surgeons performing ≥100 operations annually (9, 28), but the threshold number of thyroid procedures that differentiates high-volume from low-volume surgeons varied across studies.…”

Section: Discussionmentioning

confidence: 99%

“…(27) Additionally, several prior studies have shown that high surgeon volume is a significant predictor of improved outcomes following thyroidectomy, and has been associated with more completeness of initial operation (14, 15), shorter length of hospital stay, lower postoperative complication rates and lower costs. (9–14, 16) The lowest postoperative complication rates have been shown to be achieved by surgeons performing ≥100 operations annually (9, 28), but the threshold number of thyroid procedures that differentiates high-volume from low-volume surgeons varied across studies. (9, 28–31) Recently, a study has suggested a minimum threshold of 25 thyroid operations annually before detectable differences in outcomes may occur.…”

Section: Discussionmentioning

confidence: 99%

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Referral of Older Thyroid Cancer Patients to A High-Volume Surgeon: Results of A Multidisciplinary Physician Survey

2017

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Objective Surgical outcomes of thyroid cancer patients are improved with high-volume surgeons. However, age disparities in referral to specialist surgical centers still exist. The factors that influence decision-making regarding referral of older thyroid cancer patients to high-volume surgeons remain unknown. Methods We surveyed members of the Endocrine Society, American College of Physicians and American Academy of Family Practice. Results Overall, 269 physicians completed the survey. Patient preference (68%), transportation barriers (63%) and confidence in local surgeon (54%) were the most cited factors decreasing likelihood of referral to a high-volume surgeon. In clinical scenarios, referral rates to a high-volume surgeon were similar for patients aged 40 and 65 with a 1 cm thyroid nodule diagnostic of thyroid cancer (N=137, 54%; N=132, 52% respectively) as for an 85-year-old with a 4 cm nodule (N=148, 59%). When comorbidities were introduced, more physicians (N=186, 74%) would refer a 65-year-old with a 4 cm thyroid nodule and comorbidities, compared to an 85-year-old with the same nodule size without comorbidities. In multivariable analysis, treating >10 thyroid cancer patients/year (p <0.001, p 0.005) and endocrinology specialty (p 0.003, p 0.003) were associated with referral to a high-volume surgeon for a 65-year-old with comorbidities and an 85-year-old without comorbidities. Conclusions Understanding surgical referral patterns of older thyroid cancer patients is vital in identifying obstacles in the referral process. We found that patient factors including comorbidities, and physician factors including specialty and patient volume, influence these patterns. This is the first step towards developing targeted interventions for these patients.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Referral of Older Thyroid Cancer Patients to A High-Volume Surgeon: Results of A Multidisciplinary Physician Survey

2017

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“…This study represents an indirect measurement of surgical quality. 23 Based on these results, high-volume thyroid cancer surgeons should be referred the patients with more extensive disease.…”

Section: High-volume Surgeons Have Better Outcomesmentioning

confidence: 99%

Ensuring Quality in Thyroid Cancer Surgery

Bates¹,

Long²,

Sippel³

2017

US Endocrinology

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T hyroid cancer incidence is increasing worldwide. Though long-term survival rates are excellent, recurrence remains a significant problem, which highlights potential areas of needed improvement, including the surgical care of these patients. This review paper identifies tools and markers that can be used to improve surgical quality in thyroid cancer. Preoperative surgical planning starts with an adequate ultrasound evaluation of the cervical lymph node basins. Postoperatively, thyroglobulin and radioactive iodine uptake scans can track adequacy of resection. In addition, lymph node yield and lymph node ratios serve as indirect markers for assessing the quality of lymph node dissections. Current research also suggests that high-volume surgeons have improved oncological outcomes. Surgeons can use these tools and information to follow and potentially improve the care provided to patients. KeywordsThyroid cancer, surgical quality, ultrasound, thyroglobulin, nodal dissection Disclosure: Maria F Bates, Kristin L Long, and Rebecca S Sippel have nothing to declare in relation to this article. No funding was received in the publication of this article. This study involves a review of the literature and did not involve any studies with human or animal subjects performed by any of the authors.Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Thyroid carcinoma is one of the most common solid tumors worldwide. The incidence of thyroid cancer is increasing, with an estimated 57,000 newly diagnosed cases in the US in 2017. Approximately three-quarters of these patients are female, with the majority being between 20 and 34 years of age. Though five-year survival rates are greater than 98% overall, the disease still inflicts significant morbidity on those affected.1 At present, surgery represents the mainstay for treatment and the only option for a definitive cure. Performing the appropriate operation for thyroid carcinoma is the first step towards achieving optimal outcomes. Current quality markers in thyroid surgery are predominately based on morbidity from often transient complications, such as temporary hypoparathyroidism or recurrent laryngeal nerve palsy. In order to improve the surgical care of patients with thyroid cancer, it is important that we focus not just on safety, but also on oncologic outcomes. Given the time delay to disease recurrence, surgeons are often not aware that disease recurrence has been identified or that the recurrence may have been due to inadequate initial surgical management. In a recent retrospective view of our institutional data, we...

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“…[4][5][6][7] In addition, the authors of ''Surgeon Volume and Adequacy of Thyroidectomy for Differentiated Thyroid Cancer'' demonstrate how increasing operative volume can optimize the care of patients with differentiated thyroid cancer. 8 Adkisson et al 8 evaluated a single health care system experience with thyroid surgery for differentiated thyroid cancer. Primary outcome measures included complication rates and selected surrogate markers for completeness of oncologic resection.…”

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confidence: 99%