title: Surgeon training and use of radioactive iodine in stage I thyroid cancer patients.
abstract: BACKGROUND
  The majority of thyroid cancer diagnoses in the United States are stage I well-differentiated cancer. The use of radioactive iodine (RAI) in these low-risk patients has increased over time. The role of surgeon training in decision making regarding treatment with RAI is unknown.
  
  
  METHODS
  Thyroid surgeons affiliated with 368 hospitals associated with the US National Cancer Database (NCDB) were surveyed. Survey data were linked to the NCDB data. A multivariable weighted analysis controlling for surgeon and hospital characteristics was conducted to examine the relationship between surgeon training, continuing education and hospital-level RAI use for stage I well-differentiated thyroid cancer.
  
  
  RESULTS
  The response rate was 70% (560 of 804). In both univariate and multivariable analysis controlling for hospital case volume, practice setting and surgeon specialty, training with a thyroid surgeon was associated with less RAI use for stage I thyroid cancer (P = 0.022 and 0.028, respectively). Attending one or more professional society meetings a year was associated with a lower rate of hospital-level RAI use in univariate analysis (P = 0.044) but not multivariable analysis.
  
  
  CONCLUSIONS
  Training with a surgeon or group of surgeons who focus on thyroid surgery was associated with a lower proportion of stage I thyroid cancer patients receiving RAI after total thyroidectomy. This study emphasizes the importance of surgeon training in hospital practice patterns.
authors.affiliation: Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Schuessler
authors.forename: Mousumi
authors.initials: M
authors.lastname: Banerjee
authors.forename: Di
authors.initials: D
authors.lastname: Yang
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Stewart
authors.forename: Gerard M
authors.initials: GM
authors.lastname: Doherty
authors.forename: Megan R
authors.initials: MR
authors.lastname: Haymart
mesh_terms: D002291:Carcinoma, Papillary / Q000532:radiotherapy / Q000601:surgery; D003657:Decision Making; D004502:Education, Medical, Continuing; D005260:Female; D013502:General Surgery / Q000193:education*; D006761:Hospitals; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D013964:Thyroid Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D013965:Thyroidectomy
chemical_list: D007457:Iodine Radioisotopes