Does Surgical Volume Influence the Need for Second Surgery? A Pilot Study
Paul D Judge1, Joseph Menousek2, Jordan C Schramm3
1Otolaryngology/Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Insights
Surgical volume, not surgeon training, predicts outcomes in pediatric thyroidectomy. Higher surgeon volume is linked to fewer repeat surgeries and shorter hospital stays for children undergoing thyroidectomy.
Area of Science:
- Pediatric Surgery
- Endocrine Surgery
- Surgical Outcomes Research
Background:
- Pediatric thyroidectomy outcomes are influenced by surgeon factors.
- Understanding the impact of surgeon training and experience is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate pediatric thyroidectomy outcomes based on surgeon training, institution, and experience.
- To identify predictors of complications, length of stay, and need for reoperation.
Main Methods:
- Retrospective case series with chart review of 81 pediatric thyroidectomy patients.
- Analysis of major complications, length of stay, and repeat surgery rates.
- Comparison of outcomes based on surgeon training background and surgical volume.
Main Results:
- No significant differences in complications or repeat surgery rates were found based on surgeon training (otolaryngology vs. general/pediatric surgery).
- Higher surgeon volume (≥12 surgeries) was associated with a decreased need for repeat surgery.
- Patients treated by higher-volume surgeons had a significantly shorter length of stay (≤1 day).
Conclusions:
- Surgical volume is a significant predictor of outcomes in pediatric thyroidectomy.
- Increased surgeon experience, measured by volume, may reduce the need for reoperation and shorten hospitalizations.
Objective:
To examine outcomes of pediatric thyroidectomy in the context of training background, institution, and experience of the surgeon.
Study Design:
Case series with chart review.
Setting:
A tertiary academic medical center and a pediatric hospital.
Subjects And Methods:
Eighty-one thyroidectomy patients younger than 18 years. Outcomes were major complications (recurrent laryngeal nerve injury, permanent hypocalcemia, and wound infection), length of stay (LOS), and need for repeat surgery.
Results:
Eighty-one patients, 39 from the University of Nebraska Medical Center and 42 from the Children's Hospital and Medical Center-Omaha, were identified over a 12-year time period. No difference was found in surgeon training (otolaryngology/head and neck surgery vs general/pediatric surgery) for complications (1 vs 1, odds ratio [OR] = 0.76, 95% confidence interval [CI] = [0.05, 13.1]), LOS >1 day (5 vs 13, OR = 0.39, 95% CI = [0.13, 1.24]), or need for second surgery (4 vs 7, OR = 1.47, 95% CI = [0.39, 5.49]). Higher surgeon volume (≥12 surgeries) was found to be significant for decreased need for second surgery (3 vs 8, OR = 6.67, 95% CI = [1.57, 27.17]). Patients of higher-volume surgeons were 4.2 times more likely to stay in the hospital 1 day or less compared with those patients operated on by surgeons with less experience (7 vs 11, 95% CI = [1.59, 15.0]).
Conclusions:
Need for second surgery in pediatric thyroidectomy may be predicted by surgical volume.
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