title: Avoidable reoperations for thyroid and parathyroid surgery: effect of hospital volume.
abstract: BACKGROUND
  Hospital volume for thyroid and parathyroid surgery inversely correlates with perioperative complications. This correlation has not been made regarding the need for reoperation.
  
  
  METHODS
  We retrospectively analyzed 395 reoperative thyroid (TR) and parathyroid (PR) surgeries at a tertiary care hospital from 1999 to 2007. Based on current standards of care, reoperations were classified as avoidable or unavoidable. Public discharge data were used to classify hospitals as low-volume centers (LVC; <20 cases/yr) or high-volume centers (HVC; >/=20 cases/yr). The chi(2) test was used to determine statistical significance.
  
  
  RESULTS
  Hospital data were available for 335 reoperations (85%). There were 134 avoidable (34%) and 201 unavoidable (66%) procedures. Primary hyperparathyroidism (HPT) and thyroid cancer each accounted for a third of cases. Of PR from LVC, 77% were avoidable compared with 22% from HVC (P < .001). Of TR from LVC, 50% were avoidable versus 14% from HVC (P < .001). Operations for both primary HPT and thyroid cancer led to avoidable reoperations more frequently if performed at a LVC (P < .001).
  
  
  CONCLUSIONS
  By objective criteria, many thyroid and parathyroid reoperations are avoidable. Most originate from LVC. In addition to decreasing complication rates, thyroid and parathyroid surgery performed at HVC would decrease the need for patients to undergo reoperations.
authors.affiliation: Endocrinology and Metabolism Institute, Section of Endocrine Surgery, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Mitchell
authors.forename: Mira
authors.initials: M
authors.lastname: Milas
authors.forename: German
authors.initials: G
authors.lastname: Barbosa
authors.forename: Jazmine
authors.initials: J
authors.lastname: Sutton
authors.forename: Eren
authors.initials: E
authors.lastname: Berber
authors.forename: Allan
authors.initials: A
authors.lastname: Siperstein
mesh_terms: D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D010279:Parathyroid Diseases / Q000601:surgery*; D016105:Parathyroidectomy / Q000706:statistics & numerical data*; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy / Q000706:statistics & numerical data*