Volume-based trends in thyroid surgery

Abstract

Objective: to characterize contemporary patterns of thyroid surgical care and variables associated with access to high-volume care.

Design: cross-sectional analysis.

Setting: maryland Health Service Cost Review Commission database.

Patients: adults who underwent surgery for thyroid disease in Maryland between January 1, 1990, and July 1, 2009.

Results: overall, 21 270 thyroid surgical procedures were performed by 1034 surgeons at 51 hospitals. Procedures performed by high-volume surgeons increased from 15.7% in 1990-1999 to 30.9% in 2000-2009 (odds ratio [OR], 3.69; P < .001), while procedures performed at high-volume hospitals increased from 11.9% to 22.7% (3.46; P < .001). High-volume surgeons were more likely to perform total thyroidectomy (OR, 2.50; P < .001) and neck dissection (1.86; P < .001), had a shorter length of hospitalization (0.44; P < .001), and had a lower incidence of recurrent laryngeal nerve injury (0.46; P = .002), hypocalcemia (0.62; P < .001), and thyroid cancer surgery (0.89; P = .01). After controlling for other variables, thyroid surgery in 2000-2009 was associated with high-volume surgeons (OR, 1.76; P < .001), high-volume hospitals (2.93; P < .001), total thyroidectomy (2.67; P < .001), and neck dissection (1.28; P = .02) but was less likely to be performed for cancer (0.83; P < .001).

Conclusions: the proportion of thyroid surgical procedures performed by high-volume surgeons and in high-volume hospitals increased significantly from 1990-1999 to 2000-2009, with an increase in total thyroidectomy and neck dissection. Surgeon volume was significantly associated with complication rates. Thyroid cancer surgery was less likely to be performed by high-volume surgeons and in 2000-2009 despite an increase in surgical cases. Further investigation is needed to identify factors contributing to this trend.