TY - JOUR
T1 - Volume-based trends in thyroid surgery
AU - Gourin, Christine G.
AU - Tufano, Ralph P.
AU - Forastiere, Arlene A.
AU - Koch, Wayne M.
AU - Pawlik, Timothy M.
AU - Bristow, Robert E.
N1 - Copyright:
Copyright 2011 Elsevier B.V., All rights reserved.
PY - 2010/12
Y1 - 2010/12
N2 - Objective: To characterize contemporary patterns of thyroid surgical care and variables associated with access to high-volume care. Design: Cross-sectional analysis. Setting: Maryland Health Service Cost Review Commission database. Patients: Adults who underwent surgery for thyroid disease in Maryland between January 1, 1990, and July 1, 2009. Results: Overall, 21 270 thyroid surgical procedures were performed by 1034 surgeons at 51 hospitals. Procedures performed by high-volume surgeons increased from 15.7% in 1990-1999 to 30.9% in 2000-2009 (odds ratio [OR], 3.69; P<.001), while procedures performed at high-volume hospitals increased from 11.9% to 22.7% (3.46; P<.001). High-volume surgeons were more likely to perform total thyroidectomy (OR, 2.50; P<.001) and neck dissection (1.86; P<.001), had a shorter length of hospitalization (0.44; P<.001), and had a lower incidence of recurrent laryngeal nerve injury (0.46; P=.002), hypocalcemia (0.62; P<.001), and thyroid cancer surgery (0.89; P=.01). After controlling for other variables, thyroid surgery in 2000-2009 was associated with high-volume surgeons (OR, 1.76; P<.001), high-volume hospitals (2.93; P<.001), total thyroidectomy (2.67; P<.001), and neck dissection (1.28; P=.02) but was less likely to be performed for cancer (0.83; P<.001). Conclusions: 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.
AB - Objective: To characterize contemporary patterns of thyroid surgical care and variables associated with access to high-volume care. Design: Cross-sectional analysis. Setting: Maryland Health Service Cost Review Commission database. Patients: Adults who underwent surgery for thyroid disease in Maryland between January 1, 1990, and July 1, 2009. Results: Overall, 21 270 thyroid surgical procedures were performed by 1034 surgeons at 51 hospitals. Procedures performed by high-volume surgeons increased from 15.7% in 1990-1999 to 30.9% in 2000-2009 (odds ratio [OR], 3.69; P<.001), while procedures performed at high-volume hospitals increased from 11.9% to 22.7% (3.46; P<.001). High-volume surgeons were more likely to perform total thyroidectomy (OR, 2.50; P<.001) and neck dissection (1.86; P<.001), had a shorter length of hospitalization (0.44; P<.001), and had a lower incidence of recurrent laryngeal nerve injury (0.46; P=.002), hypocalcemia (0.62; P<.001), and thyroid cancer surgery (0.89; P=.01). After controlling for other variables, thyroid surgery in 2000-2009 was associated with high-volume surgeons (OR, 1.76; P<.001), high-volume hospitals (2.93; P<.001), total thyroidectomy (2.67; P<.001), and neck dissection (1.28; P=.02) but was less likely to be performed for cancer (0.83; P<.001). Conclusions: 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.
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U2 - 10.1001/archoto.2010.212
DO - 10.1001/archoto.2010.212
M3 - Article
C2 - 21173367
AN - SCOPUS:78650805001
SN - 0886-4470
VL - 136
SP - 1191
EP - 1198
JO - Archives of Otolaryngology--Head and Neck Surgery
JF - Archives of Otolaryngology--Head and Neck Surgery
IS - 12
ER -