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. 2021 Sep;406(6):1999-2010.
doi: 10.1007/s00423-021-02223-8. Epub 2021 Jun 9.

The volume and outcome relationship for thyroidectomy in England

William K Gray  1 , Sebastian Aspinall  2   3 , Neil Tolley  4 , Jamie Day  5 , Mark Lansdown  5   6
Affiliations

The volume and outcome relationship for thyroidectomy in England

William K Gray et al. Langenbecks Arch Surg. 2021 Sep.

Abstract

Purpose: The delivery of surgical care in England has seen a momentum towards centralisation within larger volume hospitals and surgical teams. The aim of this study was to investigate outcomes in England in relationship to hospital and surgeon annual volumes for total thyroidectomy.

Methods: Data were extracted from the Hospital Episodes Statistics (HES) database for England. A 6-year period (April 2012-March 2018 inclusive) for all adult admissions for thyroidectomy was used in the analysis. The primary outcome measure used was a length of hospital stay greater than 2 days or an emergency readmission within 30 days following surgery. This was used as a proxy for surgical complications. A multilevel modelling strategy was used to adjust for hierarchy and potentially confounding.

Results: Data for 22,823 total thyroidectomies across 144 hospital trusts were used for analysis. For total thyroidectomy, larger volume surgeons had reduced levels of post-surgical complications; length of stay > 2 and > 4 days; emergency readmission at 30 days; and hypoparathyroidism, vocal cord palsy, stridor, and tracheostomy at 1-year post-surgery. Larger hospital volume was associated with lower levels of emergency readmission at 30 days and hypoparathyroidism at 1 year.

Conclusions: There is significant correlation between surgeon volume and clinical outcome for total thyroidectomy. The relationship was approximately linear, and a low-volume threshold could not be defined.

Keywords: Hypoparathyroidism; Thyroid surgery; Thyroidectomy; Tracheostomy; Vocal cord palsy; Volume-outcome relationship.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flow diagram
Fig. 2
Fig. 2
Variation in portion of patients with complications, defined as length of stay > 2 days or readmission within 30 days, by surgeon and trust volume categories
See this image and copyright information in PMC

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