title: Associations of Volume and Thyroidectomy Outcomes: A Nationwide Study with Systematic Review and Meta-Analysis.
abstract: This study explored how different hospital volumes and surgeon volumes affect thyroidectomy outcomes in terms of length of stay (LOS), costs, and in-hospital mortality.
  
  
  
  MEDLINE and EMBASE databases.
  
  
  
  This study retrospectively analyzed a cohort of 125,037 thyroidectomy patients treated at Taiwan hospitals from 1996 to 2010. Relationships between hospital/surgeon volume and patient outcomes were retrospectively analyzed by propensity score matching. In conjunction with the retrospective study, a systematic review and meta-analysis of the relevant literature also were performed.
  
  
  
  The mean LOS for all thyroidectomies performed during the study period was 3.3 days, and the mean cost was $1193.5. Both high-volume hospitals and high-volume surgeons were associated with significantly shorter LOS and lower costs compared with their low-volume counterparts (P < .001). Different volume groups had similar in-hospital mortality rates. The meta-analysis results consistently showed that the benefits of high-volume hospitals/surgeons are reduced LOS and costs. However, low in-hospital mortality rates were associated with high-volume surgeons but not with high-volume hospitals.
  
  
  
  This meta-analysis showed that patients who received thyroidectomies performed by high-volume hospitals and surgeons had shorter LOS and lower costs compared with those treated by low-volume hospitals and surgeons. In addition, in-hospital survival rates were better in patients treated by high-volume surgeons. Further research is needed to define the learning curve for thyroidectomy and to clarify how hospital volume and surgeon volume affect its success rate.
authors.affiliation: Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Tsung-Jung
authors.initials: TJ
authors.lastname: Liang
authors.affiliation: Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Shiuh-Inn
authors.initials: SI
authors.lastname: Liu
authors.affiliation: Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: King-Tong
authors.initials: KT
authors.lastname: Mok
authors.affiliation: Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan hshi@kmu.edu.tw.
authors.forename: Hon-Yi
authors.initials: HY
authors.lastname: Shi
mesh_terms: D017721:Hospital Costs; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D057216:Propensity Score; D012189:Retrospective Studies; D015996:Survival Rate; D013624:Taiwan; D013965:Thyroidectomy / Q000191:economics / Q000706:statistics & numerical data
keywords: hospital costs; length of stay; survival; thyroidectomy; volume