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Practice Patterns in the Operative Management of Pediatric Thyroid Disease Across Surgical Specializations
Lindsay A Gil1, Jennifer N Cooper2, Kelli N Patterson1
1Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.
Insights
Pediatric surgeons most often manage pediatric thyroid disease, with variations in patient demographics and procedure types across specialties. Overall complication rates for pediatric thyroid surgery remain low.
Area of Science:
- Pediatric Surgery
- Endocrine Surgery
- Surgical Practice Patterns
Background:
- Surgical management of pediatric thyroid disease involves multiple specialties.
- Current practice patterns across these specializations are not well-defined.
Purpose of the Study:
- To examine and compare practice patterns in pediatric thyroid disease operative management.
- To analyze variations in surgical specialization, patient demographics, and outcomes.
Main Methods:
- Retrospective analysis of 1241 pediatric thyroidectomies (2015-2019) from state inpatient and ambulatory databases.
- Comparison of patient characteristics, hospital data, and clinical outcomes across surgical specializations.
- Surgeon specialization determined, including pediatric surgery, pediatric otolaryngology, general surgery, adult otolaryngology, and endocrine-focused general surgery.
Main Results:
- Pediatric surgeons performed the majority of procedures (34.9%).
- Endocrine-focused general surgeons had the highest annual volume (78.2 cases/year), while pediatric subspecialists had the lowest.
- Significant differences observed in patient age, sociodemographics, and surgical indications across specializations (p < 0.05).
Conclusions:
- Pediatric surgery is the predominant specialty for operative management of pediatric thyroid disease.
- Pediatric specialists disproportionately treat low-income, minority children and those with Graves' disease.
- Clinical outcomes, including hypocalcemia and nerve injury, were generally low across all groups.
Background:
Multiple surgical specializations are involved in the operative management of pediatric thyroid disease, but current practice patterns remain unknown. The objective of this study was to examine current practice patterns in the operative management of pediatric thyroid disease, specifically comparing practices across different surgical specializations including pediatric surgery, pediatric otolaryngology, general surgery, adult otolaryngology, and endocrine-focused general surgery.
Methods:
Children 0-18 years-old undergoing thyroid surgery from 2015 to 2019 were identified using the Healthcare Cost and Utilization Project State Inpatient Databases and State Ambulatory Surgery and Services Databases across 6 states. Surgeon specialization was determined for all included surgeons. Patient and hospital characteristics were compared across surgical specializations. Clinical outcomes including hypocalcemia/hypoparathyroidism, recurrent laryngeal nerve injury, hematoma, and wound infection were assessed.
Results:
A total of 1241 pediatric thyroidectomies performed by 363 surgeons were included. Procedures were most frequently performed by pediatric surgeons (34.9%). Only 7.2% of procedures were performed by adult general surgeons. There were statistically significant differences in patient age, sociodemographics, surgical indications, and type of procedure performed between specializations (p < 0.05). Endocrine-focused general surgeons had the highest average annual thyroid procedure volume with 78.2 cases/year, and pediatric surgeons and pediatric otolaryngologists had the lowest volumes with 0.7 and 0.6 cases/year, respectively. Overall complication rates were low.
Conclusions:
Operative management of pediatric thyroid disease was most frequently performed by pediatric surgery. Pediatric specializations are more likely to operate on low-income, minority children with public insurance and patients with Graves' disease. Overall complications were low.
Level Of Evidence:
III.
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