Effect of surgeons’ annual operative volume on the risk of permanent Hypoparathyroidism, recurrent laryngeal nerve palsy and Haematoma following thyroidectomy: analysis of United Kingdom registry of endocrine and thyroid surgery (UKRETS)

Abstract

Purpose

Categorize data to investigate the surgeon volume outcome relationship in thyroidectomies. Determine the evidence base for recommending a minimum number of thyroidectomies performed per year to maintain surgical competency.

Methods

Data on thyroid operations in the United Kingdom Registry of Endocrine and Thyroid Surgery (UKRETS) from 01/09/2010 to 31/08/2016 was analysed. The primary outcome measure was permanent hypoparathyroidism (PH). Recurrent laryngeal nerve palsy (RLN) and post-operative haematoma were also examined. Exclusion criteria included patient age > 85 or < 18 years, and surgeons contributing <10 operations. Data analysis was performed using general additive models and mixed effect logistic regression for PH and binary logistic regression for others.

Results

For PH 10313 bilateral thyroid operations were analysed. The Annual rate (AR, p = 0.012) and nodal dissection (P < 10−7) were significant factors. 25,038 thyroidectomies were analysed to investigate the effect of surgeon Volume on RLN palsy and haematoma. Age, retrosternal goitre, routine laryngoscopy, re-operation, nodal Dissection, bilateral thyroidectomy, RLN monitoring and surgeon volume were significantly associated with RLN palsy. Post-operative haematoma showed no significant correlation to surgeon volume. Categorisation of AR showed that PH and RLN palsy rates declined in surgeons performing >50 cases/year to a minimum of 3% and 2.6% respectively in highest volume AR group (>100 cases/year).

Conclusion

Surgeon annual operative volume is a factor in determining outcome from thyroid surgery. Results are limited by a high proportion of missing data, which could potentially bias the outcome, but tentatively suggests the minimum recommended number of thyroid operations / year should be 50 cases.

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Acknowledgements

The authors thank Professor John Matthews (Newcastle University, School of Mathematics & Statistics) for his help with the statistical analysis and interpretation of PH from the UKRETS data. The authors also thank the BAETS members and those who maintain and contribute to UKRETS including Dendrite clinical systems Limited.

Contributors to UKRETS

Richard Adamson, Anna Aertssen, Ahmed Afzaal, Avi Agrawal, Afzaal Ahmad, Ijaz Ahmad, Orabi Ahmad, Ibrahim Ahmed, Irfan Akhtar, Murat Akyol, Peyman Alam, Munther Aldoori, David Allen, Iain D Anderson, Sebastian Aspinall, Chris Ayshford, Ekambaram Dinakara Babu, Christopher Backhouse, Saba alasubramanian, Alistair Balfour, Neal Banga, Ludger Barthelmes, Nigel Beasley, Chris Bem, Ian Black, Stephen Blair, Richard Bliss, Victoria Brown, Robert Carpenter, Michael Carr, AndreW Carswell, Carmen de Casso Moxo, David Chadwick, Habib Charfare, Andy Chin, Edward Chisholm, Louise Clark, Peter Clarke, Helen Cocks, Peter Conboy, Luke Condon, Rogan Corbridge, Allan Paul Corder, Paul Counter, Stephen P Courtney, Eamonn Coveney, Hugh Cox, Wendy Craig, James N Crinnion, David Cunliffe, Titus Cvasciuc, Jeremy P Davis, Stuart Denholm, Ganapathy Dhanasekar, Vikram Dhar, Ann Dingle, James Docherty, Helen Doran, Julie Dunn, Fiona Eatock, Anusha Edwards, Wael Elsaify, James England, Abigail A Evans, Roy Farrell, Brian Fish, Bence Forgacs, Clare Fowler, Georgios Fragkiadakis, Gabriele Galata, Ashu Gandhi, Richard Garth, Ajith George, Nicholas Gibbins, Martin G Greaney, Thomas G Groot-Wassink, Paul Gurr, Andrew Guy, Wayne Halfpenny, Charles Hall, Paul Hans, Robert Hardy, Churunal Hari, Barney Harrison, Micheal Harron, Simon Hickey, Omar Hilmi, Tim Hoare, Jonathan Hobson, Philip Holland, Andrew Houghton, David Howe, Jonathan Hubbard, Neil Hulton, Paul Hurley, Andrew Husband, Aidah Isa, Shaun Jackson, Tony Jacob, Sharan Chakkyath Jayaram, Jean- Pierre Jeannon, Taleb Jeddy, Stephanie Jenkins, Bethan Jones, Anton Joseph, Bengt Kald, Robert Kennedy, James Kirkby-Bott Paul Kirkland, Ursula Kirkpatrick, Zygmunt Krukowski, Nirmal Kumar, Vijay Kurup, Tom Kurzawinski, Nicholas RF Lagattolla, Mark Lansdown, Nicholas Law, Tom WJ Lennard, Peter Lewis, Andrew P Locker, John RC Logie, Sean Loughran, M Lucarotti, John Lynn, Alasdair Mace, Fiona MacGregor, Paul R Maddox, Arcot Maheshwar, Zvoru Makura, Deborah Markham, Dominic Martin-Hirsch, Andrew Mccombe, Julian McGlashan, Andrew McIrvine, Andrew J McLaren, Sandy McPherson, Hesham Mehanna, Radu Mihai, Faisal MA Mihaimeed, Tedla Miroslav, George Mochloulis, James Moor, Peter Moore, Ram Moorthy, Pradeep Morar, Justin Morgan, Iain M Muir, Michael L Nicholson, Stewart Nicholson, Keshav Nigam, Iain Nixon, Janet O’Connell, Olawale Olarinde, Fausto Palazzo, Michael Papesch, Neil R Parrott, Susannah Penney, Andrew Pfleiderer, Jonathan Philpott, Lisa Pitkin, Isabel Quiroga, David Ratliff, Duraisamy Ravichandran, Venkat Reddy, David Rew, Keith Rigg, Nick Roland, Alasdair Ross, Tom Rourke, Gavin T Royle, Sarwat Sadek, Greg Sadler, Mrinal Saharay, Michael, Ahmed Samy, Klaus- Martin Schulte, David Scott-Coombes, Anup Kumar Sharma, Steve Shering, Susannah Shore, John Shotton, Richard Sim, Ricard Simo, Prakash Sinha, Gunasekaran Sinnappa, Anthony Skene, James Smellie, David M Smith, Ian Smith, Simon Smith, Roy Spence, Paul Spraggs, Adam Stacey- Clear, Frank Stafford, Michael P Stearns, Michael Stechman, Paul Stimpson, Robert Sudderick, Robert Sutclffe, Peter Tassone, Taranjit Tatla, Gareth Tervit, Paul Thomas, Adrian Thompson, Steven Thrush, Paul Tierney, Augustine Titus, Neil Tolley, Mark Tomlinson, Paul Turner, Charanjeit S Ubhi, Harpreet Uppal, Srinivasan Venkat, Richard Vowles, Alison Waghorn, Jonathan C Watkinson, Gavin Watters, John Weighill, Andrew R Welch, Hugh Wheatley, Martin Wickham, Chandana Wijewardena, Adam Wild, Michael R Williams, Simon Williams, Paul Wilson, Michail Winkler, Stephen Wood, Constantinos Yiangou, Charles Zammitt.

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Mr. Aspinall: Study conception and design, interpretation of data, Drafting of manuscript, critical revision of manuscript. Miss Oweis: Critical revision of manuscript Mr. Chadwick: Study conception and design, interpretation of data, critical revision of manuscript.

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Correspondence to S. Aspinall.

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S. Aspinall declares that he has no conflict of interest. D Oweis declares that she has no conflict of interest. D Chadwick declares that he has no conflict of interest.

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Aspinall, S., Oweis, D. & Chadwick, D. Effect of surgeons’ annual operative volume on the risk of permanent Hypoparathyroidism, recurrent laryngeal nerve palsy and Haematoma following thyroidectomy: analysis of United Kingdom registry of endocrine and thyroid surgery (UKRETS). Langenbecks Arch Surg 404, 421–430 (2019). https://doi.org/10.1007/s00423-019-01798-7

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Keywords

  • Endocrine surgery
  • Surgeon volume
  • Thyroidectomy
  • Volume-outcome
  • Chronic hypocalcaemia, permanent hypoparathyroidism, operative volume