Volume-based trends in thyroid surgery

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1191-1198
Number of pages8
JournalArchives of Otolaryngology - Head and Neck Surgery
Volume136
Issue number12
DOIs
StatePublished - Dec 1 2010

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

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