title: Surgeon volume and adequacy of thyroidectomy for differentiated thyroid cancer.
abstract: BACKGROUND
  We aimed to determine influence of surgeon volume on (1) frequency of appropriate initial surgery for differentiated thyroid cancer (DTC) and (2) completeness of resection.
  
  
  METHODS
  We reviewed all initial thyroidectomies (Tx; lobectomy and total) performed in a health system during 2011; surgeons were grouped by number of Tx cases per year. For patients with histologic DTC ≥ 1 cm, surgeon volume was correlated with initial extent of the operation, and markers of complete resection including uptake on I(123) prescan, thyrotropin-stimulated thyroglobulin levels, and I(131) dose administered.
  
  
  RESULTS
  Of 1,249 patients who underwent Tx by 42 surgeons, 29% had DTC ≥ 1 cm without distant metastasis. At a threshold of ≥ 30 Tx per year, surgeons were more likely to perform initial total Tx for DTC ≥ 1 cm (P = .01), and initial resection was more complete as measured by all 3 quantitative markers. For patients with advanced stage disease, a threshold of ≥ 50 Tx per year was needed before observing improvements in I(123) uptake (P = .004).
  
  
  CONCLUSIONS
  Surgeons who perform ≥ 30 Tx a year are more likely to undertake the appropriate initial operation and have more complete initial resection for DTC patients. Surgeon volume is an essential consideration in optimizing outcomes for DTC patients, and even higher thresholds (≥ 50 Tx/year) may be necessary for patients with advanced disease.
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Cameron D
authors.initials: CD
authors.lastname: Adkisson
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Gina M
authors.initials: GM
authors.lastname: Howell
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: McCoy
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Michaele J
authors.initials: MJ
authors.lastname: Armstrong
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Meghan L
authors.initials: ML
authors.lastname: Kelley
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Stang
authors.affiliation: Department of Endocrinology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Judith M
authors.initials: JM
authors.lastname: Joyce
authors.affiliation: Department of Radiology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Hodak
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Sally E
authors.initials: SE
authors.lastname: Carty
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA. Electronic address: yipl@upmc.edu.
authors.forename: Linwah
authors.initials: L
authors.lastname: Yip
mesh_terms: D000046:Academic Medical Centers; D001707:Biopsy, Needle; D002983:Clinical Competence; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D066231:Surgeons / Q000706:statistics & numerical data; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D000078329:Workforce