Charles Meltzer1, Marc Klau2, Deepak Gurushanthaiah3, Joanne Tsai4, Di Meng4, Linda Radler5, Alvina Sundang5. 1. Permanente Medical Group, Santa Rosa, California, U.S.A.. charles.meltzer@kp.org. 2. The Southern California Permanente Medical Group, Anaheim, California, U.S.A. 3. The Permanente Medical Group, Oakland, California, U.S.A. 4. Health Information Technology and Transformation Analytics, Kaiser Permanente, Oakland, California, U.S.A. 5. The Permanente Federation, Oakland, California, U.S.A.
Abstract
OBJECTIVES/HYPOTHESIS: To test our hypothesis that high-surgeon volume is associated with improved surgical efficiency and 30-day outcomes, and lower hospital utilization. STUDY DESIGN: Retrospective observational cohort, 2008-2013. METHODS: 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. RESULTS: 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). CONCLUSION: High-volume surgeons improve patient safety and have the potential to contribute to organizational efficiency that may be underutilized in some settings. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:2630-2639, 2016.
OBJECTIVES/HYPOTHESIS: To test our hypothesis that high-surgeon volume is associated with improved surgical efficiency and 30-day outcomes, and lower hospital utilization. STUDY DESIGN: Retrospective observational cohort, 2008-2013. METHODS: 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. RESULTS: 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). CONCLUSION: High-volume surgeons improve patient safety and have the potential to contribute to organizational efficiency that may be underutilized in some settings. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:2630-2639, 2016.
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