Literature Review: A Roundup of Important Recent Studies

Study design: Retrospective cross-sectional study of discharge data from 871,644 patients who underwent surgery for thyroid disease from 1993 through 2008.

Setting: Nationwide Inpatient Sample inpatient care database.

Synopsis: Records in the study period were divided into two time intervals: 1) 1993 through 2000 and 2) 2001 through 2008. The average number of annual thyroid surgical cases increased by 39 percent in Interval 2 compared to Interval 1. Thyroid lobectomy, the most common procedure, decreased from 69 percent in Interval 1 to 52 percent in Interval 2, while total thyroidectomy increased from 27 percent to 46 percent. During Interval 1, the largest combined category was very low-volume surgeons operating at very low-volume hospitals. During Interval 2, the largest increase was in cases performed by high-volume surgeons at high-volume hospitals; the proportion of cases performed by very low-volume surgeons and hospitals decreased, although it was still the largest combined category. High-volume surgeons were significantly more likely to be associated with teaching hospitals, to perform total thyroidectomy and to practice in urban areas; they were less likely to operate on patients admitted urgently, with advanced comorbidity, on Medicare, Medicaid or self-pay status, and to be located in Midwestern or Southern states. Surgeon volume was inversely associated with post-operative complications. Limitations included a lack of follow-up data, possible differences in patient or disease type cared for at high-volume hospitals, underreporting of complication incidence and lack of outpatient surgery data.

Bottom line: The proportion of thyroid surgical procedures performed by high-volume surgeons and high-volume hospitals increased significantly over the studied time period, and surgeon volume is a significant predictor of thyroid surgery outcomes.

Citation: Loyo M, Tufano RP, Gourin CG. National trends in thyroid surgery and the effect of volume on short-term outcomes. Laryngoscope. 2013;123:2056-2063.

—Reviewed by Amy Eckner

Younger Patients with Mucosal HNCA Have Better Survival Rates

What are the survival differences between young and older patients who have mucosal head and neck cancer (HNCA)?

Background: Epidemiological data have shown that the incidence of head and neck squamous cell carcinoma is rising in young adults, particularly over the last two decades. There is disagreement in the literature about whether young patients at all HNCA sites have better, worse or similar prognoses in comparison with older patients.

Study design: Matched pair (87 cases, aged 45 or younger, matched to 87 controls older than age 45) retrospective cohort study of mucosal HNCA patients between 2003 and 2008.