title: Surgeon volume in thyroid surgery: Surgical efficiency, outcomes, and utilization.
abstract: To test our hypothesis that high-surgeon volume is associated with improved surgical efficiency and 30-day outcomes, and lower hospital utilization.
  
  
  
  Retrospective observational cohort, 2008-2013.
  
  
  
  A total of 3,135 patients with hemithyroidectomy or total thyroidectomy performed by a high-volume surgeon, propensity score-matched to 3,135 patients with the same procedure performed by a low-volume surgeon. All-cause 30-day complication, mortality, readmission, and emergency department visit rates, proportion of outpatient procedures, cut-to-close time, and length of stay were assessed.
  
  
  
  Hemithyroidectomies: Compared to low-volume surgeons, high-volume surgeons had fewer readmitted patients (2.7% vs. 7.0%, P < .05), more outpatient procedures (46% vs. 29%, P < .05), and shorter lengths of stay (mean [standard deviation] 16.6 [22.1] vs. 21.7 [27.5] hours, P < .05) and surgical (cut-to-close) times (1.7 [0.7] vs. 2.0 [1.1] hours, P < .05). Total thyroidectomies: High-volume surgeons had lower rates of all surgery-related complications (5.7% vs. 7.5%, P < .05), hypocalcemia (4.9% vs. 7.0%, P < .05), surgical site infections (0.3% vs. 1.0%, P < .05), more outpatient procedures (13% vs. 3%, P < .05), shorter lengths of stay (29.9 [32.8] vs. 39.8 [36.2] hours, P < .05), and cut-to-close times (2.4 [1.1] vs. 3.0 [1.7] hours, P < .05).
  
  
  
  High-volume surgeons improve patient safety and have the potential to contribute to organizational efficiency that may be underutilized in some settings.
  
  
  
  4. Laryngoscope, 126:2630-2639, 2016.
authors.affiliation: Permanente Medical Group, Santa Rosa, California, U.S.A.. charles.meltzer@kp.org.
authors.forename: Charles
authors.initials: C
authors.lastname: Meltzer
authors.affiliation: The Southern California Permanente Medical Group, Anaheim, California, U.S.A.
authors.forename: Marc
authors.initials: M
authors.lastname: Klau
authors.affiliation: The Permanente Medical Group, Oakland, California, U.S.A.
authors.forename: Deepak
authors.initials: D
authors.lastname: Gurushanthaiah
authors.affiliation: Health Information Technology and Transformation Analytics, Kaiser Permanente, Oakland, California, U.S.A.
authors.forename: Joanne
authors.initials: J
authors.lastname: Tsai
authors.affiliation: Health Information Technology and Transformation Analytics, Kaiser Permanente, Oakland, California, U.S.A.
authors.forename: Di
authors.initials: D
authors.lastname: Meng
authors.affiliation: The Permanente Federation, Oakland, California, U.S.A.
authors.forename: Linda
authors.initials: L
authors.lastname: Radler
authors.affiliation: The Permanente Federation, Oakland, California, U.S.A.
authors.forename: Alvina
authors.initials: A
authors.lastname: Sundang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004526:Efficiency; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010359:Patient Readmission; D057216:Propensity Score; D012189:Retrospective Studies; D066231:Surgeons / Q000706:statistics & numerical data*; D013965:Thyroidectomy / Q000379:methods / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Thyroid; complications; surgical efficiency; thyroid surgery