High-Volume Thyroid Surgeons Have Improved Efficiency, 30-Day Outcomes

Is high-surgeon volume in thyroid surgery associated with improved surgical efficiency and 30-day outcomes, and lower hospital utilization?

BOTTOM LINE
High-volume thyroid surgeons are associated with improved patient safety and have the potential to contribute to organizational efficiency that may be underutilized in some settings.

Background: Thyroid disorders are common, with an estimated 6.6% of the U.S. population having thyroid disease and asymptomatic nodules appearing in up to 50% of autopsies. Annually, U.S. surgeons perform an estimated 118,000 to 166,000 thyroid surgeries. Many studies have demonstrated improved patient outcomes for high-volume surgeons for various complex surgical procedures.[3] This relationship has been reported for thyroid surgery, with higher volume surgeons having fewer surgical complications, shorter hospital stays, and lower readmission rates. The current literature examining the association between surgeon volume and outcomes has several limitations, including data gathered from secondary analysis of national and state independent databases, differing case mixes and patient populations.

The researchers of this study sought to use propensity score-matching methods to examine associations between surgeon volume, 30-day rates of complications, mortality, and postdischarge utilization.

Design: Retrospective observational cohort, 2008–2013. The study population consisted of unique patients with a single thyroid procedure performed by a low- or high-volume surgeon in 2008 to 2013.

Setting: Kaiser Permanente Northern California and Southern California.

Synopsis: Outcomes studied were 30-day rates of complications, postdischarge utilization, mortality, surgical cut-to-close time, length of stay, and the proportion of outpatient cases. Complications were measured dichotomously as present or not during the first 30 days after surgery and included surgery-related complications: hematoma, stridor, transient hypocalcemia, and vocal cord paralysis/paresis.

A total of 8,332 adults met inclusion criteria. Compared with patients undergoing total thyroidectomy from low-volume surgeons, patients undergoing total thyroidectomy from high-volume surgeons had lower 30-day rates of hypocalcemia (4.9% vs. 7.0%, P < .05), which was the primary contributor to lower rates of all surgery-related complications (5.7% vs. 7.5%, P < .05) and surgical site infection (0.3% vs. 1.0%, P < .05). Patients undergoing hemithyroidectomy by high-volume surgeons had lower rates of 30-day all-cause readmissions (2.7% vs. 7.0%, P < .05) and morbidity of unknown or unclear cause (0.1% vs. 0.6%, P < .05) than patients undergoing the same procedure performed by low-volume surgeons.

Compared with low-volume colleagues, high-volume surgeons who performed total thyroidectomies and hemithyroidectomies had shorter cut-to-close times (mean SD, 2.4 [1.1] vs. 3.0 [1.7] hours and 1.7 [0.7] vs. 2.0 [1.1] hours, respectively).