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. 1998 Sep;228(3):320–330. doi: 10.1097/00000658-199809000-00005

The importance of surgeon experience for clinical and economic outcomes from thyroidectomy.

J A Sosa 1, H M Bowman 1, J M Tielsch 1, N R Powe 1, T A Gordon 1, R Udelsman 1
PMCID: PMC1191485  PMID: 9742915

Abstract

OBJECTIVE: To determine whether individual surgeon experience is associated with improved short-term clinical and economic outcomes for patients with benign and malignant thyroid disease who underwent thyroid procedures in Maryland between 1991 and 1996. SUMMARY BACKGROUND DATA: There is a prevailing belief that surgeon experience affects patient outcomes in endocrine surgery, but there is a paucity of objective evidence outside of clinical series published by experienced surgeons that supports this view. METHODS: A cross-sectional analysis of all patients who underwent thyroidectomy in Maryland between 1991 and 1996 was conducted using a computerized statewide hospital discharge data base. Surgeons were categorized by volume of thyroidectomies over the 6-year study period: A (1 to 9 cases), B (10 to 29 cases), C (30 to 100 cases), and D (>100 cases). Multivariate regression was used to assess the relation between surgeon caseload and in-hospital complications, length of stay, and total hospital charges, adjusting for case mix and hospital volume. RESULTS: The highest-volume surgeons (group D) performed the greatest proportion of total thyroidectomies among the 5860 discharges, and they were more likely to operate on patients with cancer. After adjusting for case mix and hospital volume, highest-volume surgeons had the shortest length of stay (1.4 days vs. 1.7 days for groups B and C and 1.9 days for group A) and the lowest complication rate (5.1 % vs. 6.1% for groups B and C and 8.6% for group A). Length of stay and complications were more determined by surgeon experience than hospital volume, which had no consistent association with outcomes. CONCLUSIONS: Individual surgeon experience is significantly associated with complication rates and length of stay for thyroidectomy.

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Selected References

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  1. Adams D. F., Fraser D. B., Abrams H. L. The complications of coronary arteriography. Circulation. 1973 Sep;48(3):609–618. doi: 10.1161/01.cir.48.3.609. [DOI] [PubMed] [Google Scholar]
  2. Becker W. F. Presidential address: Pioneers in thyroid surgery. Ann Surg. 1977 May;185(5):493–504. doi: 10.1097/00000658-197705000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Burge M. R., Zeise T. M., Johnsen M. W., Conway M. J., Qualls C. R. Risks of complication following thyroidectomy. J Gen Intern Med. 1998 Jan;13(1):24–31. doi: 10.1046/j.1525-1497.1998.00004.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Charlson M. E., Pompei P., Ales K. L., MacKenzie C. R. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–383. doi: 10.1016/0021-9681(87)90171-8. [DOI] [PubMed] [Google Scholar]
  5. Chen H., Zeiger M. A., Gordon T. A., Udelsman R. Parathyroidectomy in Maryland: effects of an endocrine center. Surgery. 1996 Dec;120(6):948–953. doi: 10.1016/s0039-6060(96)80039-0. [DOI] [PubMed] [Google Scholar]
  6. Edis A. J. Prevention and management of complications associated with thyroid and parathyroid surgery. Surg Clin North Am. 1979 Feb;59(1):83–92. doi: 10.1016/s0039-6109(16)41735-4. [DOI] [PubMed] [Google Scholar]
  7. Farrar W. B. Complications of thyroidectomy. Surg Clin North Am. 1983 Dec;63(6):1353–1361. doi: 10.1016/s0039-6109(16)43193-2. [DOI] [PubMed] [Google Scholar]
  8. Gordon T. A., Burleyson G. P., Tielsch J. M., Cameron J. L. The effects of regionalization on cost and outcome for one general high-risk surgical procedure. Ann Surg. 1995 Jan;221(1):43–49. doi: 10.1097/00000658-199501000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hannan E. L., O'Donnell J. F., Kilburn H., Jr, Bernard H. R., Yazici A. Investigation of the relationship between volume and mortality for surgical procedures performed in New York State hospitals. JAMA. 1989 Jul 28;262(4):503–510. [PubMed] [Google Scholar]
  10. Harness J. K., Fung L., Thompson N. W., Burney R. E., McLeod M. K. Total thyroidectomy: complications and technique. World J Surg. 1986 Oct;10(5):781–786. doi: 10.1007/BF01655238. [DOI] [PubMed] [Google Scholar]
  11. Harris S. C. Thyroid and parathyroid surgical complications. Am J Surg. 1992 May;163(5):476–478. doi: 10.1016/0002-9610(92)90391-4. [DOI] [PubMed] [Google Scholar]
  12. Jollis J. G., Peterson E. D., DeLong E. R., Mark D. B., Collins S. R., Muhlbaier L. H., Pryor D. B. The relation between the volume of coronary angioplasty procedures at hospitals treating Medicare beneficiaries and short-term mortality. N Engl J Med. 1994 Dec 15;331(24):1625–1629. doi: 10.1056/NEJM199412153312406. [DOI] [PubMed] [Google Scholar]
  13. Lavernia C. J., Guzman J. F. Relationship of surgical volume to short-term mortality, morbidity, and hospital charges in arthroplasty. J Arthroplasty. 1995 Apr;10(2):133–140. doi: 10.1016/s0883-5403(05)80119-6. [DOI] [PubMed] [Google Scholar]
  14. Lieberman M. D., Kilburn H., Lindsey M., Brennan M. F. Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg. 1995 Nov;222(5):638–645. doi: 10.1097/00000658-199511000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Loré J. M., Jr Surgery of the thyroid gland. Otolaryngol Clin North Am. 1980 Feb;13(1):69–83. [PubMed] [Google Scholar]
  16. Luft H. S., Bunker J. P., Enthoven A. C. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med. 1979 Dec 20;301(25):1364–1369. doi: 10.1056/NEJM197912203012503. [DOI] [PubMed] [Google Scholar]
  17. Martin L., Delbridge L., Martin J., Poole A., Crummer P., Reeve T. S. Trainee surgery in teaching hospitals: is there a cost? Aust N Z J Surg. 1989 Mar;59(3):257–260. doi: 10.1111/j.1445-2197.1989.tb01511.x. [DOI] [PubMed] [Google Scholar]
  18. Reeve T. S., Curtin A., Fingleton L., Kennedy P., Mackie W., Porter T., Simons D., Townend D., Delbridge L. Can total thyroidectomy be performed as safely by general surgeons in provincial centers as by surgeons in specialized endocrine surgical units? Making the case for surgical training. Arch Surg. 1994 Aug;129(8):834–836. doi: 10.1001/archsurg.1994.01420320060011. [DOI] [PubMed] [Google Scholar]
  19. Romano P. S., Roos L. L., Jollis J. G. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol. 1993 Oct;46(10):1075–1090. doi: 10.1016/0895-4356(93)90103-8. [DOI] [PubMed] [Google Scholar]
  20. Roos L. L., Stranc L., James R. C., Li J. Complications, comorbidities, and mortality: improving classification and prediction. Health Serv Res. 1997 Jun;32(2):229–242. [PMC free article] [PubMed] [Google Scholar]
  21. Shaha A., Jaffe B. M. Complications of thyroid surgery performed by residents. Surgery. 1988 Dec;104(6):1109–1114. [PubMed] [Google Scholar]
  22. Shindo M. L., Sinha U. K., Rice D. H. Safety of thyroidectomy in residency: a review of 186 consecutive cases. Laryngoscope. 1995 Nov;105(11):1173–1175. doi: 10.1288/00005537-199511000-00006. [DOI] [PubMed] [Google Scholar]
  23. Tunbridge W. M., Evered D. C., Hall R., Appleton D., Brewis M., Clark F., Evans J. G., Young E., Bird T., Smith P. A. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxf) 1977 Dec;7(6):481–493. doi: 10.1111/j.1365-2265.1977.tb01340.x. [DOI] [PubMed] [Google Scholar]
  24. van Heerden J. A., Groh M. A., Grant C. S. Early postoperative morbidity after surgical treatment of thyroid carcinoma. Surgery. 1987 Feb;101(2):224–227. [PubMed] [Google Scholar]

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