Thyroidectomy Complication Rate Down When Surgeon Volume Up

For patients undergoing total thyroidectomy, the occurrence rate of complications decreases as annual surgeon volumes increase, according to a study published online in JAMA Otolaryngology-Head & Neck Surgery.

Charles Meltzer, M.D., from the Permanente Medical Group in Santa Rosa, California, and colleagues conducted a retrospective cohort study to identify the point at which increasing surgeon volume yields better outcomes. Data were included for 10,546 patients who underwent total thyroidectomy from Jan. 1, 2008, through Dec. 31, 2015.

The researchers found that in a generalized additive model, at annual surgeon procedure volumes of 18.2 and 18.1 procedures per year, the occurrence rates of vocal cord paralysis (VCP) and hypoparathyroidism began to decrease, respectively. A subsequent increase in complication rates for transient VCP was observed in the model. As annual surgeon volumes increased, statistically significant decreases were seen in the occurrence rates of complications with use of a refined model. Among all patients, 6.0, 1.6, 4.2, and 1.7 percent experienced transient and permanent hypoparathyroidism and transient and permanent VCP, respectively. When all surgeons had modeled minimum annual procedure volumes greater than 40, absolute decreases in complication rates were low, ranging from 0.6 percent for permanent VCP and hypoparathyroidism to 1.5 percent for transient hypoparathyroidism.

"The very low overall rates of these complications in our system limit the degree to which the statistically significant findings may have practical utility," the authors write.

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