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. 2023 Jul 31;12(7):917-927.
doi: 10.21037/gs-22-385. Epub 2023 Jul 10.

Lateral neck dissection surgeon volume and complications in head and neck endocrine malignancy

James C Campbell  1 , Hui-Jie Lee  2 , Trinitia Y Cannon  1 , Russel R Kahmke  1 , Walter T Lee  1 , Liana Puscas  1 , Daniel J Rocke  1
Affiliations

Lateral neck dissection surgeon volume and complications in head and neck endocrine malignancy

James C Campbell et al. Gland Surg. .

Abstract

Background: Increased surgeon volume is associated with decreased complications for many surgeries, including thyroidectomy. We sought to use two national databases to assess for associations between surgeon volume and complications in patients undergoing lateral neck dissection for thyroid or parathyroid malignancy.

Methods: Lateral neck dissections for thyroid and parathyroid cancer from the Nationwide Inpatient Sample and State Inpatient Database were analyzed. The primary outcome was any inpatient complication common to thyroidectomy, parathyroidectomy, or lateral neck dissection. The principle independent variable was surgeon volume. Multivariable analysis was then performed on this retrospective cohort study.

Results: The 1,094 Nationwide Inpatient Sample discharges had a 28% (305/1,094) complication rate. After adjustment, surgeons with volumes between 3-34 neck dissections/year demonstrated a surgeon volume-complication rate association [adjusted odds ratio: 1.03; 95% confidence interval (CI): 1.01-1.05]. The 1,235 State inpatient Database discharges had a 21% (258/1,235) overall complication rate, and no association between surgeon volume and complication rates (P=0.25).

Conclusions: This retrospective review of 2,329 discharges for patients undergoing lateral neck dissection for thyroid or parathyroidectomy demonstrated somewhat conflicting results. The Nationwide Inpatient Sample demonstrated increasing complication rates for increasing surgeon volume among intermediate volume surgeons, while the State Inpatient Database demonstrated no surgeon volume-complication association. Given these disparate results, and further limitations with these databases, conclusions regarding surgical volume and clinical decision making based on these data should be assessed cautiously.

Keywords: Neck dissection; parathyroid cancer; surgeon volume (SV); surgical outcomes; thyroid cancer.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gs.amegroups.com/article/view/10.21037/gs-22-385/coif). TYC reports that she receives consulting fees from Cook Medical for lectures on implantable dopplers. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Distribution of surgeon volume in the NIS cohort. NIS, Nationwide Inpatient Sample; SD, standard deviation; IQR, interquartile range.
Figure 2
Figure 2
Distribution of surgeon volume in the SID cohort. SID, State Inpatient Database; SD, standard deviation; IQR, interquartile range.
Figure 3
Figure 3
Unadjusted relationship between surgeon volume and odds of at least one complication in the thyroid malignancy subgroup in the Nationwide Inpatient Sample cohort. Volume was represented with restricted cubic splines and knots at the 5th, 35th, 65th, and 95th percentiles.
Figure 4
Figure 4
Unadjusted relationship between surgeon volume and odds of at least one complication in the thyroid malignancy subgroup in the State Inpatient Database cohort. Volume was represented with restricted cubic splines and knots at the 10th, 50th, and 90th percentiles.
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