Surgeon perceptions of volume threshold and essential practices for pediatric thyroidectomy^✰

Area of Science:

• Pediatric Surgery
• Surgical Oncology
• Endocrine Surgery

Background:

• Sub-specialization and regionalization of care are increasingly important in pediatric surgery.
• Thyroid surgery is a recognized sub-specialty often concentrated in specific practices.
• A national survey explored current practices and beliefs regarding pediatric thyroid surgery.

Purpose of the Study:

• To assess the current landscape of pediatric thyroid surgery practices among pediatric surgeons.
• To understand surgeon perceptions of the volume-outcome relationship in pediatric thyroid surgery.
• To identify variations in surgical techniques and perioperative management.

Main Methods:

• A national survey was distributed to non-resident members of the American Pediatric Surgical Association (APSA) in October 2020.
• Respondents were stratified by self-reported thyroid surgical experience.
• Data collected included surgical techniques, operative practices, referral patterns, and perceptions of volume-outcome relationships.

Main Results:

• Most respondents (88%) believe thyroid surgery volume impacts outcomes, with varied definitions of "high volume."
• Only 21% of respondents performed pediatric thyroid surgery in the past year.
• Routine use of recurrent laryngeal nerve monitoring was high (82%), but consensus was lacking on same-day discharge and hypocalcemia management.

Conclusions:

• Pediatric thyroid surgery is concentrated among a subset of pediatric surgeons.
• A dual operating team approach is commonly endorsed for these procedures.
• Further evidence is required to establish consensus on perioperative care standards.