Volume-Based Trends in Thyroid Surgery

Abstract

the proportion of thyroid surgical procedures performed by high-volume surgeons and in high-volume hospitals increased significantly from 1990-1999 to 2000-2009, with an increase in total thyroidectomy and neck dissection. Surgeon volume was significantly associated with complication rates. Thyroid cancer surgery was less likely to be performed by high-volume surgeons and in 2000-2009 despite an increase in surgical cases. Further investigation is needed to identify factors contributing to this trend.

The Importance of Surgical Volume on Outcomes in Thyroid Surgery Revisited: Old is in Again

“…With regard to thyroid surgery, these relationships have been demonstrated in both pediatric and geriatric thyroid patients. [2][3][4][5][6] Our study confirms previous findings as Dr. Sosa suggests, and it is currently the largest study of its kind. The fact that it confirms previous findings suggests that such findings are reproducible, and this should not be felt to be an insignificant point.…”

“…This risk, however, is mitigated when high-volume surgeons perform these operations compared with low-volume surgeons, as previously demonstrated. [2][3][4][5][6] As Dr. Sosa points out, debate currently surrounds the appropriate management for low-and medium-risk differentiated thyroid cancers\4 cm in size, and whether thyroid lobectomy or total thyroidectomy should be performed. Additionally, The American Thyroid Association released guidelines in 2009 recommending that thyroid lobectomy alone may be sufficient treatment for isolated indeterminate solitary nodules in those who prefer a more limited surgical procedure and for those with small (\1 cm), low-risk, unifocal, intrathyroidal papillary carcinomas in the absence of prior head and neck irradiation or radiologically or clinically involved cervical nodal metastases.…”

Remnant Uptake as a Postoperative Oncologic Quality Indicator

“…Lifelong complications after total thyroidectomy include recurrent laryngeal nerve injury and hypoparathyroidism, since both recurrent laryngeal nerves and all four parathyroids become at risk during removal of the entire gland. These risks diminish when a high-volume, or experienced, surgeon performs the thyroidectomy (16)(17)(18)(19)(20)(21).…”

Can the operating time be reduced by use of magnification in Total Thyroidectomy? A preliminary Study

“…Removal of the diseased gland avoids the requirement of a completion procedure in case of post operative cancer findings or late recurrence which is fraught with complications such as recurrent laryngial nerve damage. High volume thyroid centers conventionally defined as a unit which does over 100 total thyroidectomies a year naturally allow surgeons to acquire high degree of technical skills and experience with minimal complications (2). Professorial surgical unit of teaching hospital, Karapitiya, Galle (THK) is such a centre owing to high prevalence of thyroid disease in Galle district, the catchment area.…”