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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2014

01-11-2014 | Head and Neck Oncology

Total Thyroidectomy is Associated with Increased Risk of Complications for Low- and High-Volume Surgeons

Authors: Adam Hauch, MD, MBA, Zaid Al-Qurayshi, MBChB, MPH, Gregory Randolph, MD, FACS, Emad Kandil, MD, FACS

Published in: Annals of Surgical Oncology | Issue 12/2014

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Abstract

Background

There has been an increased use of total thyroidectomy (TT), including in the management of benign thyroid diseases. We sought to compare the risk of complications between TT and unilateral thyroidectomy (UT) and to evaluate the effect of surgeon’s experience on outcomes.

Methods

Nationwide Inpatient Sample from 2003 to 2009 was used to perform cross-sectional analysis of all adult patients who underwent TT and UT for benign or malignant conditions. Logistic regression was used to evaluate outcomes and to provide correlation between outcome and surgeon volume. Surgeon volume was categorized as low or high (performing <10 or >99 thyroid operations/year, respectively).

Results

A total of 62,722 procedures were included. Most cases were TT (57.9 %) performed for benign disease. There was a significantly increased risk of complication after TT compared to UT (20.4 vs. 10.8 %: p < 0.0001). High-volume surgeons performed only 5.0 % of the procedures overall, with 62.6 % of the high-volume surgeon procedures being TTs. Low-volume surgeons were more likely to have postoperative complications after TT compared to high-volume surgeons (odds ratio 1.53, 95 % confidence interval 1.12, 2.11, p = 0.0083). Mean charges were significantly higher for TT compared to lobectomy ($19,365 vs. $15,602, p < 0.0001), and length of stay was longer for TT compared to lobectomy (1.63 vs. 1.29 days, p < 0.0001).

Conclusions

TT is associated with a significantly higher risk of complications compared to UT even among high-volume surgeons. Higher surgeon volume is associated with improved patient outcomes.
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Metadata
Title
Total Thyroidectomy is Associated with Increased Risk of Complications for Low- and High-Volume Surgeons
Authors
Adam Hauch, MD, MBA
Zaid Al-Qurayshi, MBChB, MPH
Gregory Randolph, MD, FACS
Emad Kandil, MD, FACS
Publication date
01-11-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 12/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3846-8

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