Educational Objective: At the conclusion of this presentation, the participants should be able to determine the impact of surgeon specialization (SS) and surgical case volume (SCV) on patient outcomes for thyroidectomy.
Objectives: To investigate outcomes associated with surgeon specialization (SS) and surgical case volume (SCV) for thyroidectomy patients.
Study Design: Retrospective database analysis.
Methods: The 2003-2009 National Inpatient Sample was queried for thyroidectomy cases. SS was defined as the percentage of cases performed by the surgeon that were thyroidectomies and SCV as the total thyroidectomy cases performed per surgeon per year. Surgeons were further divided into quartiles based on SS and SCV. Univariate and multivariate analyses were performed.
Results: 51,360 cases of thyroidectomy were identified. Overall, average SS was 13.8% (range: 0.00%-100.0%) and average SCV was 26.1 cases (range: 1-126). Overall patient mortality (1.0% vs. 0.3%, p<0.001) and adverse discharge disposition rates (7.0% vs. 1.6%, p<0.001) decreased as SS increased. Similarly, overall patient in-hospital mortality (1.2% vs. 0.2%, p<0.001) and adverse disposition rates (6.8% vs. 1.3%, p<0.001) decreased as SCV increased. Logistic regression showed decreased odds of in-hospital mortality (OR 0.27, 95% CI: 0.15-0.49, p<0.001) and decreased odds of adverse disposition (OR 0.22, 95% CI: 0.18-0.28, p<0.001) for the highest SS quartile compared to the lowest. Similarly, decreased odds of in-hospital mortality (OR 0.17, 95% CI: 0.12-0.24, p<0.001) and adverse disposition (OR 0.18, 95% CI: 0.16-0.21, p<0.001) was demonstrated in the highest SCV quartile compared to the lowest.
Conclusions: Increased surgeon specialization for thyroidectomy and case volume were each significantly associated with improved mortality and discharge disposition. On multivariate analysis, each was also significantly associated with lower likelihood of in-hospital mortality and adverse disposition following discharge.