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Surgeons with more annual thyroid removals have lower risk for complication

More than half of doctors who remove thyroids do it once a year, nearly doubling a patient's risk for complications.
By Stephen Feller   |   March 14, 2016 at 4:49 PM

DURHAM, N.C., March 14 (UPI) -- While there's no guaranteed way to prevent post-surgical complications, finding a surgeon who removes a lot of thyroids can significantly lower the risk of a complication, Duke University researchers found in a recent study.

Just over half the doctors who perform thyroidectomies do so just once a year, nearly doubling the risk for complications over doctors who perform 25 or more of the procedure per year, according to the study.

Thyroid removal is common because of cancer, over-activity or enlargement, but researchers say the procedure is complicated. The thyroid, located at the base of the throat, produces hormones that regulate metabolism. In some cases, bleeding, problems with the parathyroid gland and difficult speaking, breathing and swallowing.

The risks to quality of care and cost, researchers say, make it worth considering a surgeon who performs more of the surgeries per year.

"Surgeon volume is one factor doctors and patients should consider as we talk about value-based care -- helping patients get appropriate care at an optimized cost and with fewer complications," Dr. Julie Sosa, chief of endocrine surgery at Duke University, said in a press release.

For the study, published in the Annals of Surgery, researchers analyzed data on 16,954 patients who had their thyroid removed between 1998 and 2009.

The median annual number of cases for surgeons was seven, and 51 percent of surgeons performed the procedure once a year. Overall, 6 percent of patients experienced complications.

Compared to doctors who perform more than 25 thyroidectomies per year, doctors performing the surgery once a year had an 87 percent increased risk of complication, those performing two to five surgeries per year carried a 68 percent increased risk, those performing six to 10 surgeries per year a 42 percent increased risk, those with 11 to 15 surgeries a 22 percent increased risk, those with 16 to 20 surgeries a 10 percent risk, and those performing 21 to 25 per year had a 3 percent higher risk of complication.

 

"This is a very technical operation, and patients should feel empowered to ask their surgeons how many procedures they do each year, on average," Sosa said. "Surgeons have an ethical responsibility to report their case numbers. While this is not a guarantee of a positive outcome, choosing a more experienced surgeon certainly can improve the odds that the patient will do well."

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