The impact of surgical volume on patient outcomes following thyroid surgery.
BACKGROUND
This study aimed to evaluate the effects of indications for thyroidectomy on patient outcomes and to examine the impact of surgical volume on these outcomes.


METHODS
The nationwide inpatient sample was used to identify all patients who underwent total thyroidectomy (TT) between 2000 and 2009. We examined the effects of surgeon volume and hospital characteristics on predicting patient outcomes. Univariate and multivariate analyses were used to examine the effects of the indication for surgical care on postoperative outcomes.


RESULTS
Overall, 46,261 procedures were identified. Patients with Graves disease had the highest postoperative complications (17.5%) compared to patients undergoing TT for other benign (13.9%) and malignant (13.2%) thyroid disease (P < .001). After stratification by surgeon volume, Graves disease was found to be a significant predictor of postoperative complications in surgeries performed by low- and intermediate-volume surgeons (P < .05). However, Graves disease was not a significant predictor of postoperative complications when performed by high volume surgeons (P = .81). Hospital volume had an inconsistent and marginal protective effect on postoperative outcomes.


CONCLUSIONS
Surgery for Graves disease is associated with a higher risk for complications when performed by less experienced surgeons. This finding should prompt recommendations for increasing surgical specialization and referrals to high-volume surgeons in the management of Graves disease.
Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA. Electronic address: ekandil@tulane.edu.
Emad
E
Kandil
Salem I
SI
Noureldine
Ali
A
Abbas
Ralph P
RP
Tufano
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006111:Graves Disease / Q000601:surgery; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013043:Specialties, Surgical; D013959:Thyroid Diseases / Q000601:surgery; D013964:Thyroid Neoplasms / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult