title: A national analysis of trends, outcomes and volume-outcome relationships in thyroid surgery.
abstract: OBJECTIVE
  Thyroid conditions are common, and their incidence is increasing. Surgery is the mainstay treatment for many thyroid conditions, and understanding its utilisation trends and morbidity is central to improving patient care.
  
  
  METHODS
  An N = near-all analysis of the English administrative dataset to identify trends in thyroid surgery specialisation, volume-outcome relationships, and the incidence and risk factors for short- and long-term morbidity.
  
  
  METHODS
  Between 2004 and 2012, 72 594 patients underwent elective thyroidectomy in England. Information about age, sex, morbidities, nature of thyroid disease and surgery, adjuvant treatments and complications including hypocalcaemia and vocal palsy was recorded.
  
  
  RESULTS
  Mean age at surgery was 49 ± 30, and a female predominance (82%) was observed. Most patients underwent hemithyroidectomy (51%) or total thyroidectomy (32%). Patients underwent surgery for benign (52.5%), benign inflammatory (21%) and malignant (17%) thyroid diseases. Thyroid surgery grew by 2.9% a year and increased in specialisation. Increased surgeon volume significantly reduced lengths of stay: the proportion of length of stay outliers fell from 11.8% for patients of occasional thyroidectomists (<5 per year) to 2.8% for patients of high-volume surgeons (>50 thyroidectomies a year). Post-discharge vocal palsy and hypocalcaemia occurred in 1.87% and 1.58% of cases, respectively. High-volume surgeons had a reduced incidence of vocal palsy, and volumes >30 were consistently protective.
  
  
  CONCLUSIONS
  Thyroid surgery is increasingly specialised. High-volume surgeons, that is patients who perform 50 or more thyroidectomies per year, achieve lower complications and shorter lengths of stay.
authors.affiliation: Department of ENT Surgery, Auckland City Hospital, Auckland, New Zealand.|National Institute for Health and Care Excellence (2013) Scholar, London, England.
authors.forename: S A R
authors.initials: SA
authors.lastname: Nouraei
authors.affiliation: Department of ENT Surgery, Royal London Hospital, London, England.
authors.forename: J S
authors.initials: JS
authors.lastname: Virk
authors.affiliation: Dr Foster Intelligence Ltd, London, England.
authors.forename: S E
authors.initials: SE
authors.lastname: Middleton
authors.affiliation: Dr Foster Unit at Imperial College, Department of Primary Care and Public Health, Imperial College London, London, England.
authors.forename: P
authors.initials: P
authors.lastname: Aylin
authors.affiliation: Department of ENT Surgery, Charing Cross Hospital, London, England.
authors.forename: A
authors.initials: A
authors.lastname: Mace
authors.affiliation: Department of ENT Surgery, University College Hospital, London, England.
authors.forename: F
authors.initials: F
authors.lastname: Vaz
authors.affiliation: Department of ENT Surgery, Barking Havering and Redbridge NHS Trust, Romford, England.
authors.forename: H
authors.initials: H
authors.lastname: Kaddour
authors.affiliation: Academic Surgical Unit, Department of Surgery and Cancer, Imperial College Healthcare Trust, St Mary's Hospital, London, England.
authors.forename: A
authors.initials: A
authors.lastname: Darzi
authors.affiliation: Department of ENT Surgery, St Mary's Hospital, London, England.
authors.forename: N S
authors.initials: NS
authors.lastname: Tolley
mesh_terms: D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012307:Risk Factors; D012737:Sex Factors; D013038:Specialization; D013959:Thyroid Diseases / Q000453:epidemiology / Q000601:surgery*; D013965:Thyroidectomy / Q000639:trends*