Is There a Minimum Number of Thyroidectomies a Surgeon Should Perform to Optimize Patient Outcomes?
Is There a Minimum Number of Thyroidectomies a Surgeon Should Perform to Optimize Patient Outcomes?
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DOI：
10.1097/sla.0000000000001688
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发表时间：
2017-02-01
影响因子：
9
通讯作者：
Sosa, Julie A.
中科院分区：
文献类型：
--
作者：
Adam, Mohamed Abdelgadir;Thomas, Samantha;Sosa, Julie A.
目的：确定每位外科医生每年进行的总甲状腺切除术数量与并发症风险最低相关。背景：甲状腺切除术的外科医生手术量结果关联已建立；然而，定义“高容量”外科医生的病例阈值仍不清楚。方法：从医疗保健利用项目全国住院患者样本（1998-2009）中确定接受甲状腺全切除术的成人。采用受限三次样条的多变量逻辑回归来检查每位外科医生每年进行的甲状腺全切除术次数与并发症风险之间的关系。结果：在 16,954 名接受全甲状腺切除术的患者中，47% 患有甲状腺癌，53% 患有良性疾病。年手术量中位数为 7 例； 51% 的外科医生每年进行 1 例手术。总体而言，6% 的患者出现并发症。调整后，随着外科医生手术量增加至每年 26 例，出现并发症的可能性降低（P < 0.01）。在所有患者中，81% 的患者接受了小批量外科医生的手术（每年 25 例甲状腺切除术），这与患者预后的改善相关。确定定义高手术量甲状腺外科医生的病例阈值很重要，因为它对质量改进、转诊和报销标准以及外科教育具有影响。
Objective: To determine the number of total thyroidectomies per surgeon per year associated with the lowest risk of complications.Background: The surgeon volume outcome association has been established for thyroidectomy; however, a threshold number of cases defining a "high-volume" surgeon remains unclear.Methods: Adults undergoing total thyroidectomy were identified from the Health Care Utilization Project-National Inpatient Sample (1998-2009). Multivariate logistic regression with restricted cubic splines was utilized to examine the association between the number of annual total thyroidectomies per surgeon and risk of complications.Results: Among 16,954 patients undergoing total thyroidectomy, 47% had thyroid cancer and 53% benign disease. Median annual surgeon volume was 7 cases; 51% of surgeons performed 1 case/y. Overall, 6% of the patients experienced complications. After adjustment, the likelihood of experiencing a complication decreased with increasing surgeon volume up to 26 cases/y (P < 0.01). Among all patients, 81% had surgery by low-volume surgeons (25 total thyroidectomies/y) that is associated with improved patient outcomes. Identifying a threshold number of cases defining a high-volume thyroid surgeon is important, as it has implications for quality improvement, criteria for referral and reimbursement, and surgical education.