The authors have no funding, financial relationships, or conflicts of interest to disclose.
National trends in thyroid surgery and the effect of volume on short-term outcomes
Article first published online: 4 JUN 2013
© 2012 The American Laryngological, Rhinological and Otological Society, Inc.
Volume 123, Issue 8, pages 2056–2063, August 2013
How to Cite
Loyo, M., Tufano, R. P. and Gourin, C. G. (2013), National trends in thyroid surgery and the effect of volume on short-term outcomes. The Laryngoscope, 123: 2056–2063. doi: 10.1002/lary.23923
- Issue published online: 19 JUL 2013
- Article first published online: 4 JUN 2013
- Manuscript Accepted: 8 NOV 2012
- Manuscript Revised: 8 OCT 2012
- Manuscript Received: 13 AUG 2012
- thyroid neoplasms;
- recurrent laryngeal nerve injury;
- Nationwide Inpatient Sample
To characterize contemporary patterns of thyroid surgical care and the effect of volume status on surgical care and short-term outcomes.
Retrospective cross-sectional study.
Discharge data from the Nationwide Inpatient Sample for 871,644 patients who underwent surgery for thyroid disease in 1993 through 2008 were analyzed using cross-tabulations and multivariate regression modeling.
Surgical cases increased from 364,288 in 1993 through 2000 to 507,356 in 2001 through 2008, with an increase in thyroid cancer surgical cases from 28% to 34%. Cases performed by high-volume surgeons increased from 12% in 1993 through 2000 to 25% in 2001 through 2008, whereas cases performed by very-low volume surgeons decreased from 51% to 34% (P < .001). Cases performed at high-volume hospitals increased from 14% in 1993 through 2000 to 29% in 2001 through 2008, whereas cases performed at very-low volume hospitals decreased from 46% to 33% (P < .001). High-volume surgeons were significantly more likely to perform total thyroidectomy (odds ratio [OR] = 1.4, P < .001) and had a lower incidence of recurrent laryngeal nerve injury (OR = 0.7, P = .024), hypocalcemia (OR = 0.7, P = .002), and in-hospital death (OR = 0.3, P = .004). High-volume hospital care was not associated with extent of surgery, postoperative morbidity, or mortality after adjusting for surgeon volume. After controlling for other variables, thyroid surgery in 2001 through 2008 was associated with an increase in cases performed by low-volume (relative risk ratio [RRR] = 1.5, P < .001), intermediate-volume (RRR = 1.7, P < .001), and high-volume surgeons (RRR = 2.1, P < .001), high-volume hospitals (RRR = 2.0, P = .008), total thyroidectomy (RRR = 2.1, P < .001), and neck dissection (RRR = 1.3, P = .016).
These data reflect changing trends in the surgical management of thyroid disease, with meaningful differences in the type of surgical care provided by high-volume surgeons.
Level of Evidence
2c. Laryngoscope, 123:2056–2063, 2013