title: Influence of experience on performance of individual surgeons in thyroid surgery: prospective cross sectional multicentre study.
abstract: OBJECTIVE
  To determine the association between surgeons' experience and postoperative complications in thyroid surgery.
  
  
  METHODS
  Prospective cross sectional multicentre study.
  
  
  METHODS
  High volume referral centres in five academic hospitals in France.
  
  
  METHODS
  All patients who underwent a thyroidectomy undertaken by every surgeon in these hospitals from 1 April 2008 to 31 December 2009.
  
  
  METHODS
  Presence of two permanent major complications (recurrent laryngeal nerve palsy or hypoparathyroidism), six months after thyroid surgery. We used mixed effects logistic regression to determine the association between length of experience and postoperative complications.
  
  
  RESULTS
  28 surgeons completed 3574 thyroid procedures during a one year period. Overall rates of recurrent laryngeal nerve palsy and hypoparathyroidism were 2.08% (95% confidence interval 1.53% to 2.67%) and 2.69% (2.10% to 3.31%), respectively. In a multivariate analysis, 20 years or more of practice was associated with increased probability of both recurrent laryngeal nerve palsy (odds ratio 3.06 (1.07 to 8.80), P=0.04) and hypoparathyroidism (7.56 (1.79 to 31.99), P=0.01). Surgeons' performance had a concave association with their length of experience (P=0.036) and age (P=0.035); surgeons aged 35 to 50 years had better outcomes than their younger and older colleagues.
  
  
  CONCLUSIONS
  Optimum individual performance in thyroid surgery cannot be passively achieved or maintained by accumulating experience. Factors contributing to poor performance in very experienced surgeons should be explored further.
authors.affiliation: Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon F-69003, France. antoineduclos@yahoo.fr
authors.forename: Antoine
authors.initials: A
authors.lastname: Duclos
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Peix
authors.forename: Cyrille
authors.initials: C
authors.lastname: Colin
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Kraimps
authors.forename: Fabrice
authors.initials: F
authors.lastname: Menegaux
authors.forename: François
authors.initials: F
authors.lastname: Pattou
authors.forename: Fréderic
authors.initials: F
authors.lastname: Sebag
authors.forename: Sandrine
authors.initials: S
authors.lastname: Touzet
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Bourdy
authors.forename: Nicolas
authors.initials: N
authors.lastname: Voirin
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lifante
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004704:Endocrinology / Q000592:standards; D005260:Female; D013502:General Surgery / Q000592:standards*; D006801:Humans; D007011:Hypoparathyroidism / Q000453:epidemiology* / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D013965:Thyroidectomy / Q000592:standards*; D013997:Time Factors; D014826:Vocal Cord Paralysis / Q000453:epidemiology* / Q000209:etiology