BACKGROUND: There has been an increased use of total thyroidectomy (TT), including in the management of benign thyroid diseases. We sought to compare the risk of complications between TT and unilateral thyroidectomy (UT) and to evaluate the effect of surgeon's experience on outcomes. METHODS: Nationwide Inpatient Sample from 2003 to 2009 was used to perform cross-sectional analysis of all adult patients who underwent TT and UT for benign or malignant conditions. Logistic regression was used to evaluate outcomes and to provide correlation between outcome and surgeon volume. Surgeon volume was categorized as low or high (performing <10 or >99 thyroid operations/year, respectively). RESULTS: A total of 62,722 procedures were included. Most cases were TT (57.9 %) performed for benign disease. There was a significantly increased risk of complication after TT compared to UT (20.4 vs. 10.8 %: p < 0.0001). High-volume surgeons performed only 5.0 % of the procedures overall, with 62.6 % of the high-volume surgeon procedures being TTs. Low-volume surgeons were more likely to have postoperative complications after TT compared to high-volume surgeons (odds ratio 1.53, 95 % confidence interval 1.12, 2.11, p = 0.0083). Mean charges were significantly higher for TT compared to lobectomy ($19,365 vs. $15,602, p < 0.0001), and length of stay was longer for TT compared to lobectomy (1.63 vs. 1.29 days, p < 0.0001). CONCLUSIONS: TT is associated with a significantly higher risk of complications compared to UT even among high-volume surgeons. Higher surgeon volume is associated with improved patient outcomes.
BACKGROUND: There has been an increased use of total thyroidectomy (TT), including in the management of benign thyroid diseases. We sought to compare the risk of complications between TT and unilateral thyroidectomy (UT) and to evaluate the effect of surgeon's experience on outcomes. METHODS: Nationwide Inpatient Sample from 2003 to 2009 was used to perform cross-sectional analysis of all adult patients who underwent TT and UT for benign or malignant conditions. Logistic regression was used to evaluate outcomes and to provide correlation between outcome and surgeon volume. Surgeon volume was categorized as low or high (performing <10 or >99 thyroid operations/year, respectively). RESULTS: A total of 62,722 procedures were included. Most cases were TT (57.9 %) performed for benign disease. There was a significantly increased risk of complication after TT compared to UT (20.4 vs. 10.8 %: p < 0.0001). High-volume surgeons performed only 5.0 % of the procedures overall, with 62.6 % of the high-volume surgeon procedures being TTs. Low-volume surgeons were more likely to have postoperative complications after TT compared to high-volume surgeons (odds ratio 1.53, 95 % confidence interval 1.12, 2.11, p = 0.0083). Mean charges were significantly higher for TT compared to lobectomy ($19,365 vs. $15,602, p < 0.0001), and length of stay was longer for TT compared to lobectomy (1.63 vs. 1.29 days, p < 0.0001). CONCLUSIONS: TT is associated with a significantly higher risk of complications compared to UT even among high-volume surgeons. Higher surgeon volume is associated with improved patient outcomes.
Authors: Yuri E Nikiforov; Raja R Seethala; Giovanni Tallini; Zubair W Baloch; Fulvio Basolo; Lester D R Thompson; Justine A Barletta; Bruce M Wenig; Abir Al Ghuzlan; Kennichi Kakudo; Thomas J Giordano; Venancio A Alves; Elham Khanafshar; Sylvia L Asa; Adel K El-Naggar; William E Gooding; Steven P Hodak; Ricardo V Lloyd; Guy Maytal; Ozgur Mete; Marina N Nikiforova; Vania Nosé; Mauro Papotti; David N Poller; Peter M Sadow; Arthur S Tischler; R Michael Tuttle; Kathryn B Wall; Virginia A LiVolsi; Gregory W Randolph; Ronald A Ghossein Journal: JAMA Oncol Date: 2016-08-01 Impact factor: 31.777
Authors: Bryan R Haugen; Erik K Alexander; Keith C Bible; Gerard M Doherty; Susan J Mandel; Yuri E Nikiforov; Furio Pacini; Gregory W Randolph; Anna M Sawka; Martin Schlumberger; Kathryn G Schuff; Steven I Sherman; Julie Ann Sosa; David L Steward; R Michael Tuttle; Leonard Wartofsky Journal: Thyroid Date: 2016-01 Impact factor: 6.568
Authors: Brooke Nickel; Kirsten Howard; Juan P Brito; Alexandra Barratt; Ray Moynihan; Kirsten McCaffery Journal: JAMA Otolaryngol Head Neck Surg Date: 2018-10-01 Impact factor: 6.223