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Published on: May 12, 2023
Pediatric thyroidectomies: A surgical subspecialty comparison
Emily Savoca1, Sina J Torabi1, David Kasle1
1Section of Otolaryngology, Head and Neck Surgery, Yale School of Medicine, New Haven, CT, USA.
Insights
Pediatric thyroidectomy is safe, with similar complication rates between Pediatric General Surgery and Otolaryngology specialists. Pediatric General Surgeons perform these thyroidectomies more quickly.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Thyroidectomy
Background:
- Thyroidectomy is performed in pediatric patients for various indications.
- Management of pediatric thyroidectomies is often shared between Pediatric General Surgery and Otolaryngology.
Purpose of the Study:
- To assess the safety and outcomes of pediatric thyroidectomies.
- To compare complication rates and management between Pediatric General Surgery and Otolaryngology.
Main Methods:
- Analysis of the National Surgical Quality Improvement Program - Pediatrics (NSQIP-P) database (2012-2016).
- Inclusion of 516 pediatric thyroidectomy cases.
- Subgroup analysis comparing Otolaryngology and Pediatric General Surgery.
Main Results:
- Low rates of overall surgical (1.2%) and medical (0.7%) adverse events.
- No significant differences in adverse events, reoperation, or readmission between specialties.
- Pediatric General Surgery associated with shorter operative times (p < 0.001).
- Different indications for surgery: benign neoplasm more common in Otolaryngology, thyrotoxicosis more common in Pediatric General Surgery.
Conclusions:
- Pediatric thyroidectomy is a safe procedure regardless of surgical specialty.
- No significant differences in adverse outcomes between Pediatric General Surgeons and Otolaryngologists.
- Pediatric General Surgeons demonstrate shorter operative times.
Objective:
This study aims to establish the typical population, safety, and outcomes of pediatric thyroidectomies, specifically identifying surgical complication rates. Furthermore, the study compares management and complication differences between the two specialties that most often manage these patients - Pediatric General Surgery and Otolaryngology.
Methods:
National Surgical Quality Improvement Program - Pediatrics (NSQIP-P) data between the years of 2012 and 2016 was reviewed and analyzed for patient characteristics, perioperative course and outcomes. Sub-group analysis was used to compare groups based on surgeon sub-specialty: Otolaryngology or Pediatric General Surgery.
Results:
The study identified 516 cases pediatric patients operated on by Pediatric Otolaryngology (229; 44.4%) and Pediatric General Surgery (287; 55.6%). Overall, rates of surgical and medical adverse events were low (1.2% and 0.7%, respectively). Upon univariate analysis, there were no differences between specialties in surgical adverse events (p = 1.000), medical adverse events (p = 0.196), reoperation (p = 0.505), or readmission (p = 0.262). Indication for surgery differed between specialties, with benign neoplasm more common in the Pediatric Otolaryngology group (48.9% vs. 35.2%), and thyrotoxicosis more common in the Pediatric General Surgery group (43.9% vs. 23.1%) (p < 0.001). Compared to cases done by Otolaryngology, Pediatric General Surgery was independently associated with a shorter operative time (B: -31.583 min [95% CI: -42.802 to -20.364]; p < 0.001).
Conclusion:
Thyroidectomy in the pediatric population is a safe procedure with no differences in adverse outcomes noted when comparing Pediatric General Surgeons to Pediatric Otolaryngologists. Pediatric General Surgeons were observed to have a significantly shorter operative time.
