Effect of surgeon volume on pediatric thyroid surgery outcomes: A systematic review | 6430 patients | 54.9% of all patients underwent total thyroidectomy | Systematic review of 10 studies | Common indications for surgery | malignancy (41.7%) | hyperthyroidism/thyroiditis (40.5%) | Across studies, rates were | transient hypocalcemia (11.4% - 74.2%) | transient recurrent laryngeal nerve injury (0% - 9.7%) | bleeding (0.5% - 4.3%) | Definitions of high-volume pediatric thyroid surgeons | >9 annual pediatric thyroid operations | >200 annual thyroid operations (>30 peds cases) | 4 Studies showed significantly better outcomes: | lower post-operative complications | shorter length of hospital stay | for patients treated by high-volume surgeons. | Conclusion: Pediatric thyroid patients have generally better outcomes when operated on by higher volume surgeons. | https://doi.org/10.1016/j.jpedsurg.2021.12.005 | @EmTombash | @StayCurrentMD | Source: Olson SL et.al. | Division of Pediatric Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago | Cincinnati Children's | Journal of Pediatric Surgery
Effect of surgeon volume on pediatric thyroid surgery
Infographic · Jan 2023 · 1 min read
In brief
In brief
This systematic review of 6,430 pediatric thyroidectomy cases examines the relationship between surgeon volume and outcomes. Despite varied definitions of high-volume surgeons, four studies found significantly better outcomes including fewer complications and shorter hospital stays when children were treated by higher-volume surgeons.
- Higher-volume surgeons demonstrate significantly lower complication rates and shorter hospital stays for pediatric thyroidectomy patients.
- Transient hypocalcemia remains the most common complication, occurring in 11-74% of cases depending on surgeon volume and technique.
- No consensus exists on defining 'high-volume' — thresholds range from ≥9 to >200 annual thyroid cases with pediatric subset.
- Concentrating pediatric thyroidectomy cases to fewer surgeons within practices may improve outcomes through volume-outcome relationship.
- Most pediatric thyroidectomies are performed for malignancy (42%) or hyperthyroidism/thyroiditis (41%), with total thyroidectomy most common.
Written by the GCMD Library team from the infographic.
Multi-panel infographic with teal header and yellow conclusion box. Left side features calendar and clock icons alongside thyroid anatomy illustration. Center displays large statistics in purple text. Bottom section uses bullet points and surgical team illustration to present complication rates and study findings. Color scheme uses teal, yellow, pink, and blue throughout.
Infographic by Em Tombash
"Effect of surgeon volume on pediatric thyroid surgery outcomes: A systematic review" Sydney L. Olson et.al.
Full article: https://www.jpedsurg.org/article/S0022-3468(21)00834-4/fulltext
Authors: Sydney L. Olson, Martha-Conley E. Ingram, Peter M. Graffy, Peggy M. Murphy, Yao Tian, Jill H. Samis, Jami L. Josefson, Jeffery C. Rastatter, Mehul V. Raval
Abstract
Background
Pediatric thyroidectomy has been identified as a surgical procedure that may benefit from concentrating cases to high-volume surgeons. This systematic review aimed to address the definition of “high-volume surgeon” for pediatric thyroidectomy and to examine the relationship between surgeon volume and outcomes.
Methods
PubMed, Embase, Cochrane Library, Scopus, Web of Science, ClinicalTrials.gov, and OpenGrey databases were searched for through February 2020 for studies which reported on pediatric thyroidectomy and specified surgeon volume and surgical outcomes.
Results
Ten studies, encompassing 6430 patients, were included in the review. Five single-center retrospective studies reported only on high-volume surgeons, one single center retrospective study reported on only low-volume surgeons, and four national database studies (2 cross sectional, 2 retrospective reviews) reported outcomes for both high-volume and low-volume surgeons. Majority of patients underwent total thyroidectomy (54.9%); common indications for surgery were malignancy (41.7%) and hyperthyroidism/thyroiditis (40.5%). Rates of transient hypocalcemia (11.4% - 74.2%), transient recurrent laryngeal nerve injury (0% - 9.7%), and bleeding (0.5% - 4.3%) varied across studies. Definitions for high-volume pediatric thyroid surgeons ranged from ≥9 annual pediatric thyroid operations to >200 annual thyroid operations (with >30 pediatric cases). Four studies reported significantly better outcomes, including lower post-operative complications and shorter length of hospital stay, for patients treated by high-volume surgeons.
Conclusions
Despite significant variation in caseloads to define volume, pediatric thyroid patients have generally better outcomes when operated on by higher volume surgeons. Concentration thyroidectomy cases to a smaller cohort of surgeons within pediatric practices may confer improved outcomes.
Level of evidence
Systematic Reviews and Meta-Analyses; Level IV