Thyroid Surgery Outcomes at a Children's Hospital: The Value of a Multidisciplinary Team Approach
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In brief
In brief
This retrospective study of 294 pediatric thyroid operations demonstrates that a structured multidisciplinary approach with evidence-based pathways achieves complication rates comparable to high-volume centers, with only 2% permanent hypoparathyroidism and 0.7% RLN injury at 12 months. The program's success in managing complex cases including Graves disease and thyroid malignancy supports the value of team-based care models in pediatric endocrine surgery.
Written by the GCMD Library team from the article.
Background
Our purpose is to describe the structure, function and outcomes of our multidisciplinary pediatric thyroid program and to evaluate our experience in comparison to other high-volume centers.
Methods
We reviewed all thyroid operations performed 10/2012 through 09/2019, and examined number of cases per year, patient demographics, procedures, final diagnoses and results. Primary outcomes were hypoparathyroidism and recurrent laryngeal nerve (RLN) injury at 12 months. Data were analyzed using descriptive statistics and univariate analyses.
Results
We performed 294 thyroid operations on 279 patients. Seventy-nine percent were female. Median age was 15 years (IQR: 12-17). Operations included total thyroidectomy (65%), lobectomy (30%) and completion thyroidectomy (5%). Most common diagnoses were Graves' disease (35%), malignancy (29%), and benign nodule (20%). We developed an evidence-based clinical pathway and conducted weekly multidisciplinary meetings. A clinical data specialist reviewed process and outcome measures routinely. Overall, 6 patients (2.0%) had hypoparathyroidism and 2 (0.7%) had unilateral RLN injury at 12 months. Two of the patients with clinical suspicion of permanent hypoparathyroidism were ultimately weaned off calcium. Both patients with RLN injury had extensive locally advanced malignant disease involving the nerve.
Conclusions
Our multidisciplinary team achieved excellent long-term outcomes for pediatric thyroid surgery comparable to other high-volume pediatric and adult centers.