Who performs endocrine operations in the United States?
BACKGROUND
Endocrine surgery is a discipline that is dedicated to high-quality care of patients with endocrine surgical disease. The relationship between its "identity" as a separate field and clinical practice patterns is not known.


METHODS
The National Inpatient Sample was searched by the International Classification of Diseases-9th revision-Clinical Modification codes for parathyroidectomy, thyroidectomy, and adrenalectomy for the years 1988 through 2000. The surgeons who performed these operations were profiled by 2 methods: Method A, by the percentage of the total primary International Classification of Diseases-9th revision-Clinical Modification procedure codes that were the selected endocrine procedures; method B, by absolute number of index endocrine procedures performed per year. Only patients with complete coding data for the surgeons were included.


RESULTS
In this sample, surgeons whose practice was comprised of 25% or less of these endocrine procedures performed 11,071 parathyroidectomies (78% of total), 46,210 thyroidectomies (82% of total), and 4209 adrenalectomies (94% of total). In contrast, surgeons whose practice was comprised of more than 75% of these endocrine procedures performed 769 parathyroidectomies (5% of total), 1560 thyroidectomies (3% of total), and 128 adrenalectomies (3% of total).


CONCLUSIONS
If these data can be extrapolated to indicate generalized practice patterns, the majority of common operations for endocrine disease are performed by surgeons whose practice is not focused on endocrine surgery. However, much of this effect is due to the fact that non-endocrine surgeons far outnumber endocrine surgeons. This understanding of clinical practice patterns will be important to consider during future studies that seek to determine the relationship between surgeon volume and patient outcomes.
Saunders
Brian D
BD
Department of Surgery, Divisions of Endocrine Surgery and Vascular Surgery, University of Michigan, 1500 E. Medical Center Drive, Taubman Center 2920H, Ann Arbor, MI 48109-0331, USA.
Wainess
Reid M
RM
Dimick
Justin B
JB
Doherty
Gerard M
GM
Upchurch
Gilbert R
GR
Gauger
Paul G
PG
D000315:Adrenalectomy / Q000706:statistics & numerical data; D013507:Endocrine Surgical Procedures / Q000706:statistics & numerical data*; D004700:Endocrine System Diseases / Q000601:surgery*; D004704:Endocrinology / Q000706:statistics & numerical data*; D013502:General Surgery / Q000706:statistics & numerical data*; D006801:Humans; D016105:Parathyroidectomy / Q000706:statistics & numerical data; D011364:Professional Practice / Q000458:organization & administration; D013965:Thyroidectomy / Q000706:statistics & numerical data; D014481:United States