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Association of Surgical Volume and Quality Management in Thyroid Surgery: A Two-Nation Multicenter Study

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Abstract

Background

High-volume caseload in thyroid surgery is associated with lower postoperative complication rates resulting to better outcomes. The aim of the present study was to investigate the correlation of the departments’ annual number of thyroid surgeries on the adherence to consensus guidelines and on the implementation of measures for quality assurance.

Methods

In 2016, we sent an anonymous electronic survey with questions related to the perioperative management in thyroid surgery to all directors of departments in operative medicine in Switzerland and Austria. We compared the pre- and postoperative management with the summarized recommendations of the four most frequently used consensus guidelines. Analogously, we analyzed the implementation of six measures for quality assurance related to thyroid surgery for each participating department. Using logistic regression analysis, we evaluated the correlation of number of guidelines respected and number of measures for quality assurance with the departments’ annual number of surgeries performed. Furthermore, we evaluated the number of departments providing thyroid cancer surgery and their experience in neck dissection.

Results

The management corresponded in 64.0% to the summarized recommendations. Adherence to the summarized recommendations and implementation of measures for quality assurance were significantly more likely with increasing numbers of surgeries performed (p = 0.049 and p < 0.001). Ninety-two departments provided thyroid cancer surgery, whereas 12/92 (13.0%) were not able to perform central and/or lateral neck dissection.

Conclusion

Consensus guidelines are insufficiently implemented within thyroid surgery, and quality management is associated with surgical volume.

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References

  1. Trautmann F, Reissfelder C, Pecqueux M et al (2018) Evidence-based quality standards improve prognosis in colon cancer care. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 44:1324–1330

    Google Scholar 

  2. Sosa JA, Bowman HM, Tielsch JM et al (1998) The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 228:320–330

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Kandil E, Noureldine SI, Abbas A et al (2013) The impact of surgical volume on patient outcomes following thyroid surgery. Surgery 154:1346–1352 (discussion 1352–1343)

    Article  PubMed  Google Scholar 

  4. Loyo M, Tufano RP, Gourin CG (2013) National trends in thyroid surgery and the effect of volume on short-term outcomes. The Laryngoscope 123:2056–2063

    Article  PubMed  Google Scholar 

  5. Gourin CG, Tufano RP, Forastiere AA et al (2010) Volume-based trends in thyroid surgery. Arch Otolaryngol Head Neck Surg 136:1191–1198

    Article  PubMed  Google Scholar 

  6. Chang CM, Huang KY, Hsu TW et al (2012) Multivariate analyses to assess the effects of surgeon and hospital volume on cancer survival rates: a nationwide population-based study in Taiwan. PLoS ONE 7:e40590

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Wang TS, Sosa JA (2018) Thyroid surgery for differentiated thyroid cancer—recent advances and future directions. Nat Rev Endocrinol 14:670–683

    Article  CAS  PubMed  Google Scholar 

  8. Adam MA, Thomas S, Youngwirth L et al (2017) Is there a minimum number of thyroidectomies a surgeon should perform to optimize patient outcomes? Ann Surg 265:402–407

    Article  PubMed  Google Scholar 

  9. Federal Office of Public Health FOPH (2016) Quality indicators Number of cases. https://www.bag.admin.ch/bag/de/home/zahlen-und-statistiken/zahlen-fakten-zu-spitaelern/qualitaetsindikatoren-der-schweizer-akutspitaeler/qualitaetsindikatoren-fallzahl.html. Accessed 01 Sept 2018

  10. Federal Institute Statistics Austria STAT (2016) Number of cases. https://www.statistik.at/web_de/statistiken/menschen_und_gesellschaft/gesundheit/index.html. Accessed 01 Sept 2018

  11. Gharib H, Papini E, Garber JR et al (2016) American association of clinical endocrinologists, American college of endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules–2016 update. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol 22:622–639

    Google Scholar 

  12. Haugen BR, Alexander EK, Bible KC et al (2016) 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid Off J Am Thyroid Assoc 26:1–133

    Article  Google Scholar 

  13. Pacini F, Castagna MG, Brilli L et al (2012) Thyroid cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol Off J Eur Soc Med Oncol 23(Suppl 7):vii110–vii119

    Google Scholar 

  14. Dralle H, Musholt TJ, Schabram J et al (2013) German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors. Langenbecks Arch Surg 398:347–375

    Article  PubMed  Google Scholar 

  15. Harris PE (2002) The management of thyroid cancer in adults: a review of new guidelines. Clin Med 2:144–146

    Article  Google Scholar 

  16. Pitoia F, Ward L, Wohllk N et al (2009) Recommendations of the Latin American Thyroid Society on diagnosis and management of differentiated thyroid cancer. Arquivos brasileiros de endocrinologia e metabologia 53:884–887

    Article  PubMed  Google Scholar 

  17. Martinez Trufero J, Capdevilla J, Cruz JJ et al (2011) SEOM clinical guidelines for the treatment of thyroid cancer. Clin Transl Oncol Off Publ Fed Span Oncol Soc Natl Cancer Inst Mexico 13:574–579

    Google Scholar 

  18. National Cancer Comprehensive Network (2013) NCCN guidelines—thyroid carcinoma. Version 2. http://www.nccn.org. Accessed 01 Sept 2018

  19. Links TP, Huysmans DA, Smit JW et al (2007) Guideline ‘Differentiated thyroid carcinoma’, including diagnosis of thyroid nodules. Ned Tijdschr Geneeskd 151:1777–1782

    CAS  PubMed  Google Scholar 

  20. Swiss Visceral Surgeon (2016) Arbeitsgruppe Endokrine Chirurgie. http://www.viszeralchirurgie.ch/?id=211. Accessed 01 Sept 2018

  21. Austrian Society of Surgery [Österreichische Gesellschaft der Chirurgie] (2016) Vorstand. https://oegch.at/vorstand/. Accessed 01 Sept 2018

  22. Qualtrics Team (2017) The qualtrics experience management platform. https://www.qualtrics.com. Accessed 01 Sept 2018

  23. Swiss Medical Association [Foederatio Medicorum Helveticorum] (FMH). Swiss Institute for Postgraduate and Further Education in Medicine [Schweizerisches Institut für ärztliche Weiter- und Fortbildung] (SIWF). Facharzt für Chirurgie—Weiterbildungsprogramm vom 1. Juli 2006. https://www.fmh.ch/files/pdf19/chirurgie_version_internet_d.pdf. Accessed 01 Sept 2018

  24. Kumbhar SS, Malley RB, Robinson TJ et al (2016) Why thyroid surgeons are frustrated with radiologists: lessons learned from pre- and postoperative US. Radiogr Rev Publ Radiol Soc North Am Inc 36:2141–2153

    Google Scholar 

  25. Rubio GA, Koru-Sengul T, Vaghaiwalla TM et al (2017) Postoperative outcomes in graves’ disease patients: results from the nationwide inpatient sample database. Thyroid Off J Am Thyroid Assoc 27:825–831

    Article  Google Scholar 

  26. Phitayakorn R, Morales-Garcia D, Wanderer J et al (2013) Surgery for Graves’ disease: a 25-year perspective. Am J Surg 206:669–673

    Article  PubMed  Google Scholar 

  27. Runciman WB, Hunt TD, Hannaford NA et al (2012) CareTrack: assessing the appropriateness of health care delivery in Australia. Med J Aust 197:100–105

    Article  PubMed  Google Scholar 

  28. Gagliardi AR, Brouwers MC (2015) Do guidelines offer implementation advice to target users? A systematic review of guideline applicability. BMJ Open 5:e007047

    Article  PubMed  PubMed Central  Google Scholar 

  29. Pronovost PJ (2013) Enhancing physicians’ use of clinical guidelines. JAMA 310:2501–2502

    Article  CAS  PubMed  Google Scholar 

  30. Adirim T, Meade K, Mistry K et al (2017) A new era in quality measurement: the development and application of quality measures. Pediatrics 139:e20163442

    Article  PubMed  Google Scholar 

  31. Zindel J, Kaderli RM, Jakob MO et al (2018) Electronic voting to improve morbidity and mortality conferences. World J Surg 41(11):3474–3481

    Article  Google Scholar 

  32. Leece P, Bhandari M, Sprague S et al (2006) Does flattery work? A comparison of 2 different cover letters for an international survey of orthopedic surgeons. Can J Sur J canadien de chirurgie 49:90–95

    Google Scholar 

  33. Gutknecht S, Kaderli R, Businger A (2012) Perception of semiquantitative terms in surgery. Ann Surg 255:589–594

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank all the surgeons who took part in this survey. Furthermore, we thank Harpreet Mandhair, Department for Biomedical Research (DBMR), University of Bern, Switzerland, for the critical revision of the manuscript.

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Author notes

  1. Dominik A. Jakob and Philipp Riss contributed equally to this work.

Authors and Affiliations

  1. Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland

    Dominik A. Jakob, Corina Kim-Fuchs, Christian A. Seiler & Reto M. Kaderli

  2. Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria

    Philipp Riss & Christian Scheuba

  3. Department of Surgery, Krankenanstalt Rudolfstiftung, Vienna, Austria

    Michael Hermann

  4. Department of Nuclear Medicine, Geneva University and University Hospitals of Geneva, Geneva, Switzerland

    Martin A. Walter

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  1. Dominik A. Jakob
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Contributions

PR and RMK designed the study. PR and RMK obtained clinical data. DAJ, CK, MAW, and RMK analyzed data. DAJ and RMK wrote the first draft of the manuscript. All authors contributed to the interpretation of the data and writing of the manuscript and approved the final version of the manuscript. RMK supervised all aspects of study design, data acquisition, analyses, and manuscript writing.

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Correspondence to Reto M. Kaderli.

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All authors declare no potential conflict of interest.

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Jakob, D.A., Riss, P., Scheuba, C. et al. Association of Surgical Volume and Quality Management in Thyroid Surgery: A Two-Nation Multicenter Study. World J Surg 43, 2218–2227 (2019). https://doi.org/10.1007/s00268-019-05012-z

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