Does surgeon volume on pediatric thyroidectomy matters?

Topic overview

New article you should know! by @gigenace

"Effect of surgeon volume on pediatric thyroid surgery outcomes: A systematic review" Syned 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

Intended audience: Healthcare professionals and clinicians.