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Multicenter Study
. 2012 Jan 10:344:d8041.
doi: 10.1136/bmj.d8041.

Influence of experience on performance of individual surgeons in thyroid surgery: prospective cross sectional multicentre study

Antoine Duclos  1 , Jean-Louis Peix, Cyrille Colin, Jean-Louis Kraimps, Fabrice Menegaux, François Pattou, Fréderic Sebag, Sandrine Touzet, Stéphanie Bourdy, Nicolas Voirin, Jean-Christophe Lifante; CATHY Study Group
Collaborators, Affiliations
Multicenter Study

Influence of experience on performance of individual surgeons in thyroid surgery: prospective cross sectional multicentre study

Antoine Duclos et al. BMJ. .

Abstract

Objective: To determine the association between surgeons' experience and postoperative complications in thyroid surgery.

Design: Prospective cross sectional multicentre study.

Setting: High volume referral centres in five academic hospitals in France.

Participants: All patients who underwent a thyroidectomy undertaken by every surgeon in these hospitals from 1 April 2008 to 31 December 2009.

Main outcome measures: Presence of two permanent major complications (recurrent laryngeal nerve palsy or hypoparathyroidism), six months after thyroid surgery. We used mixed effects logistic regression to determine the association between length of experience and postoperative complications.

Results: 28 surgeons completed 3574 thyroid procedures during a one year period. Overall rates of recurrent laryngeal nerve palsy and hypoparathyroidism were 2.08% (95% confidence interval 1.53% to 2.67%) and 2.69% (2.10% to 3.31%), respectively. In a multivariate analysis, 20 years or more of practice was associated with increased probability of both recurrent laryngeal nerve palsy (odds ratio 3.06 (1.07 to 8.80), P=0.04) and hypoparathyroidism (7.56 (1.79 to 31.99), P=0.01). Surgeons' performance had a concave association with their length of experience (P=0.036) and age (P=0.035); surgeons aged 35 to 50 years had better outcomes than their younger and older colleagues.

Conclusions: Optimum individual performance in thyroid surgery cannot be passively achieved or maintained by accumulating experience. Factors contributing to poor performance in very experienced surgeons should be explored further.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: that all authors received support from the French Ministry of Health for the submitted work; no relationships with any company that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow diagram of procedures in analysis of recurrent laryngeal nerve palsy
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Fig 2 Flow diagram of procedures in analysis of hypoparathyroidism
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Fig 3 Surgeon performance curve by permanent complication. Points were above zero if the surgeon’s performance was higher than predicted by the risk model, and below zero if the performance was lower than predicted.
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