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Published on: May 12, 2023
Initial outcomes at a nascent tertiary pediatric thyroid surgical center
David M Bruss1, Alexander J Kovacs2, Himala Kashmiri3
1California Northstate University, College of Medicine, Elk Grove, CA, 95757, United States; University of California, Irvine School of Medicine, Department of Otolaryngology- Head and Neck Surgery, Orange, CA, 92868, United States; CHOC Children's Hospital of Orange County, Division of Pediatric Otolaryngology- Head and Neck Surgery, Orange, CA, 92868, United States.
Insights
Newly established pediatric thyroid surgery centers can achieve low complication rates, comparable to high-volume centers. This study demonstrates that new centers can safely begin with lower volumes and transition to higher patient throughput.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Endocrinology
Background:
- High-volume centers are often associated with better outcomes in pediatric thyroid surgery.
- Nascent surgical practices face challenges in achieving comparable results.
Purpose of the Study:
- To evaluate the initial outcomes of a new pediatric thyroid surgery practice.
- To determine if a low-volume center can safely evolve into a higher-volume center.
- To assess the feasibility of achieving favorable outcomes at centers with lower patient volumes.
Main Methods:
- Retrospective chart review of pediatric thyroid surgeries from 2014-2020.
- Analysis of postoperative complications, including recurrent laryngeal nerve injury and hypoparathyroidism.
- Involvement of a multidisciplinary team including pediatric otolaryngologists and endocrinologists.
Main Results:
- 31 pediatric patients underwent thyroid surgery, with 9 having neck dissections.
- Low complication rates observed: 2.0% permanent recurrent laryngeal nerve paralysis and 2.7% permanent hypoparathyroidism.
- Common diagnoses included papillary thyroid carcinoma (46.9%) and follicular adenoma (18.8%).
Conclusions:
- Favorable outcomes are achievable in nascent pediatric thyroid surgery centers with initially low volumes.
- New centers can safely transition to intermediate or high-volume status.
- This approach can enhance patient access to specialized pediatric thyroid surgical care.
Objectives:
Previous studies on pediatric thyroid surgical complications suggest that high-volume centers achieve improved outcomes. We hypothesize that initial outcomes from a nascent pediatric surgical practice may be comparable to higher volume centers. Furthermore, we determine whether a low-volume center can safely transition to an intermediate or high-volume center.
Methods:
A retrospective chart review was performed for all pediatric patients undergoing thyroid surgery at a single institution from 2014 to 2020. Surgeries were performed by two pediatric otolaryngologists. All patients were managed postoperatively by a multidisciplinary team of physicians that included pediatric otolaryngologists and endocrinologists. Data collection focused on patient demographics and postoperative complications, including rates of recurrent laryngeal nerve injury and permanent hypoparathyroidism.
Results:
From 2014 to 2020, a total of 31 patients underwent thyroid surgery at our pediatric thyroid surgery center, 9 of whom underwent neck dissection. The mean age of our cohort was 14.4 ± 3.9 years (range 8 months-20 years). Postoperative pathology results revealed that 15 patients (46.9%) were diagnosed with PTC, 6 (18.8%) with follicular adenoma, and 4 (15.6%) with benign thyroid tissue. One (2.0%) patient had permanent unilateral recurrent laryngeal nerve paralysis and one patient experienced permanent hypoparathyroidism (2.7%).
Conclusions:
Our initial low complication rate as a nascent pediatric thyroid surgery center suggests that favorable outcomes can be achieved at lower volume surgery centers. In order to increase patient access to high-volume pediatric thyroid surgery centers, new centers must start with lower volumes before ultimately becoming high-volume centers. Our study shows that this can be safely achieved.
Level Of Evidence:
IV.
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