Pediatric endocrine surgery: who is operating on our children?
BACKGROUND
High surgeon volume is associated with improved outcomes in adult endocrine surgery. This is the first population-based outcomes study for thyroidectomy/parathyroidectomy in children.


METHODS
Cross-sectional analyses were performed using 1999 to 2005 Healthcare Cost and Utilization Project Nationwide Inpatient Sample data. Outcomes included complications, length of stay (LOS), and costs. High-volume surgeons performed >30 cervical endocrine procedures per year in adults and children; pediatric surgeons restricted >90% of their practices to patients </=17 years old. Other surgeons fell into neither category. Bivariate and multivariate regression analyses were performed.


RESULTS
We included 607 patients, representing 20% of the pediatric endocrine operations done between 1999 and 2005 in the United States. Seventy-six percent of patients were female. Among the procedures performed, 92% were thyroidectomies and 8% were parathyroidectomies. Surgeons were classified as follows: 18% High-volume, 21% Pediatric, and 61% Other. High-volume surgeons had the lowest LOS (1.5 days vs 2.3 Pediatric, 2.0 Other; P = .01), costs ($12,474 vs $19,594 Pediatric, $13,614 Other; P < .01), and complications (6% vs 11% Pediatric, 10% Other; P = NS). In multivariate analyses, case volume of the endocrine surgeons was an independent predictor of LOS and costs.


CONCLUSIONS
High-volume surgeons have better outcomes after thyroidectomy/parathyroidectomy in children compared with Pediatric and Other surgeons. Surgeon experience was an independent predictor of LOS and costs. High-volume endocrine and pediatric surgeons could combine expertise to improve outcomes in children.
Tuggle
Charles T
CT
Department of Surgery, Yale University School of Medicine, New Haven, Conn, USA.
Roman
Sanziana A
SA
Wang
Tracy S
TS
Boudourakis
Leon
L
Thomas
Daniel C
DC
Udelsman
Robert
R
Ann Sosa
Julie
J
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D013502:General Surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D010279:Parathyroid Diseases / Q000601:surgery*; D016105:Parathyroidectomy / Q000191:economics / Q000706:statistics & numerical data*; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy / Q000191:economics / Q000706:statistics & numerical data*; D000078329:Workforce