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Published on: June 9, 2023
Pediatric thyroid cancer patients referred to high-volume facilities have improved short-term outcomes
Linda M Youngwirth1, Mohamed A Adam1, Samantha M Thomas1
1Duke University Medical Center, Durham, NC.
Insights
Pediatric thyroid cancer patients treated at lower-volume hospitals face higher readmission risks. High-volume centers improve outcomes for children with this rare endocrine malignancy.
Area of Science:
- Pediatric oncology
- Endocrine surgery
- Health services research
Background:
- Thyroid cancer is the most common endocrine malignancy in children.
- While rare, pediatric thyroid cancer necessitates specialized care.
- Facility case volume may impact patient outcomes.
Purpose of the Study:
- To assess the association between treatment facility case volume and outcomes for pediatric thyroid cancer patients.
- To identify if higher case volumes correlate with improved patient outcomes.
- To evaluate the impact of facility volume on 30-day readmission rates.
Main Methods:
- Utilized the National Cancer Data Base (1998-2011) for pediatric thyroid cancer cases (age ≤ 18).
- Defined facility case volume by the number of pediatric thyroid cancer patients treated.
- Employed restricted cubic spline modeling and logistic regression to analyze volume's effect on 30-day readmission.
Main Results:
- Analyzed 4,466 pediatric thyroid cancer patients; 79.1% were girls.
- Patients at high-volume facilities were more likely to have medullary thyroid cancer and undergo total thyroidectomy.
- Treatment at low-volume facilities was linked to a 3.52-fold increased likelihood of 30-day readmission (P=.01).
Conclusions:
- Pediatric thyroid cancer patients treated at low-volume facilities experience higher readmission rates post-surgery.
- Facility case volume is a critical factor influencing outcomes in pediatric thyroid cancer care.
- Referrals for pediatric thyroid surgery should consider the treating facility's case volume status.
Background:
Thyroid cancer is the most common endocrine malignancy in children, albeit still rare. This study sought to measure the association between outcomes and case volume of the treatment facility for pediatric patients with thyroid cancer.
Methods:
The National Cancer Data Base (1998-2011) was queried for all pediatric patients (age ≤ 18 years) with thyroid cancer. Demographic, clinical, and pathologic features were evaluated for all patients. Case volume of the treating facility was defined as the number of pediatric thyroid cancer patients at that facility during the study period. Restricted cubic spline modeling was used to determine a volume threshold associated with decreased risk of 30-day readmission. Patients were assigned to volume groups based on this threshold. Logistic regression was utilized to estimate the effect of volume on 30-day readmission.
Results:
In total, 4,466 patients met inclusion criteria. The majority were girls (79.1%), white (86.1%), and underwent total thyroidectomy (86.9%). Compared with patients treated at the low-volume facilities, those treated at the high-volume facilities were more likely to have medullary thyroid cancer (10.7% versus 3.7%) and undergo total thyroidectomy (90.8% versus 86.3%) (all P < .01). After adjustment, treatment at low-volume facilities was associated with an increased likelihood of readmission after operative treatment (odds ratio = 3.52, P = .01).
Conclusion:
Pediatric patients with thyroid cancer treated at low-volume facilities are more likely to be readmitted after thyroid surgery than patients treated at high-volume facilities. Providers should consider the case volume status at the treating facility when referring these children for thyroid surgery.
