Outcomes Analysis in Thyroid Surgery: A Review of Patient and Provider Predictors

  • Tracy S. Wang
  • Julie Ann Sosa


In the past decade, there has been a litany of large, population-based studies demonstrating that clinical and economic outcomes from a number of surgical procedures are superior at hospitals that perform these procedures in high volumes. This “volume-outcomes” relationship is most compelling for cardiovascular operations (e.g., coronary artery bypass graft surgery [CABG], abdominal aortic aneurysm repair) and major cancer resections (e.g., pancreatic cancer resection, esophagectomy). These reviews suggest that thousands of preventable surgical deaths occur each year in the United States because elective surgery is performed in hospitals that have inadequate experience. Studies have also demonstrated an association between surgeon experience and patient outcomes, which appear to be independent of hospital volume.


Thyroid Cancer Recurrent Laryngeal Nerve Total Thyroidectomy Laryngeal Nerve Thyroid Surgery 
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  1. 1.
    Luft HS, Bunker JP, Enthoven AC (1979) Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med 301:1364–1369PubMedCrossRefGoogle Scholar
  2. 2.
    Hannan EL, O’Donnell JF, Kilburn H Jr, Bernard HR, Yazici A (1989) Investigation of the relationship between volume and mortality for surgical procedures performed in New York State hospitals. JAMA 262:503–510PubMedCrossRefGoogle Scholar
  3. 3.
    Begg CB, Cramer LD, Hoskins WJ, Brennan MF (1998) Impact of hospital volume on operative mortality for major cancer surgery. JAMA 280:1747–1751PubMedCrossRefGoogle Scholar
  4. 4.
    Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346:1128–1137PubMedCrossRefGoogle Scholar
  5. 5.
    Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL (2003) Surgeon volume and operative mortality in the United States. N Engl J Med 349:2117–2127PubMedCrossRefGoogle Scholar
  6. 6.
    Chowdhury MM, Dagash H, Pierro A (2007) A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg 94:145–161PubMedCrossRefGoogle Scholar
  7. 7.
    Boudourakis L, Wang TS, Roman SA, Desai R, Sosa JA (2009) Evolution of the surgeon-volume, patient-outcome relationship. Ann Surg 250:159–165PubMedCrossRefGoogle Scholar
  8. 8.
    Reeve TS, Curtin A, Fingleton L, Kennedy P, Mackie W, Porter T, Simons D, Townend D, Delbridge L (1994) Can total thyroidectomy be performed as safely by general surgeons in provincial centers as by surgeons in specialized endocrine surgical units? Making the case for surgical training. Arch Surg 129:834–836PubMedCrossRefGoogle Scholar
  9. 9.
    Mishra A, Agarwal G, Agarwal A, Mishra SK (1999) Safety and efficacy of total thyroidectomy in hands of endocrine surgery trainees. Am J Surg 178:377–380PubMedCrossRefGoogle Scholar
  10. 10.
    Connolly TM, Watters DA (2010) Monitoring performance in thyroidectomy: cumulative sum analysis of outcomes. Thyroid 20:407–412PubMedCrossRefGoogle Scholar
  11. 11.
    Yim JH, Carty SE (2010) Thyroid surgery and surgeons: the common interest. Thyroid 20:357–358PubMedCrossRefGoogle Scholar
  12. 12.
    Sakorafas GH (2010) Historical evolution of thyroid surgery: from the ancient times to the dawn of the 21st century. World J Surg 34:1793–1804PubMedCrossRefGoogle Scholar
  13. 13.
    Becker WF (1977) Presidential address: pioneers in thyroid surgery. Ann Surg 185:493–504PubMedCrossRefGoogle Scholar
  14. 14.
    Colcock BP (1968) Lest we forget: a story of five surgeons. Surgery 64:1162–1172PubMedGoogle Scholar
  15. 15.
    Stojadinovic A, Shaha AR, Orlikoff RF, Nissan A, Kornak MF, Singh B, Boyle JO, Shah JP, Brennan MF, Kraus DH (2002) Prospective functional voice assessment in patients undergoing thyroid surgery. Ann Surg 236:823–832PubMedCrossRefGoogle Scholar
  16. 16.
    Echternach M, Maurer CA, Mencke T, Schilling M, Verse T,Richter B (2009) Laryngeal complications after thyroidectomy: is it always the surgeon? Arch Surg 144:149–153, ­discussion 153PubMedCrossRefGoogle Scholar
  17. 17.
    Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, Pelizzo MR, Pezzullo L (2004) Complications of thyroid ­surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 28:271–276PubMedCrossRefGoogle Scholar
  18. 18.
    Toniato A, Boschin IM, Piotto A, Pelizzo MR, Guolo A, Foletto M, Casalide E (2008) Complications in thyroid surgery for carcinoma: one institution’s surgical experience. World J Surg 32:572–575PubMedCrossRefGoogle Scholar
  19. 19.
    White ML, Gauger PG, Doherty GM (2007) Central lymph node dissection in differentiated thyroid cancer. World J Surg 31:895–904PubMedCrossRefGoogle Scholar
  20. 20.
    Moo TA, McGill J, Allendorf J, Lee J, Fahey T 3rd, Zarnegar R (2010) Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma. World J Surg 34:1187–1191PubMedCrossRefGoogle Scholar
  21. 21.
    Shindo M, Stern A (2010) Total thyroidectomy with and without selective central compartment dissection: a comparison of complication rates. Arch Otolaryngol Head Neck Surg 136:584–587PubMedCrossRefGoogle Scholar
  22. 22.
    Morton RP, Whitfield P, Al-Ali S (2006) Anatomical and surgical considerations of the external branch of the superior laryngeal nerve: a systematic review. Clin Otolaryngol 31:368–374PubMedCrossRefGoogle Scholar
  23. 23.
    Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, Grond S, Muhlig HP, Richter C, Voss J, Thomusch O, Lippert H, Gastinger I, Brauckhoff M, Gimm O (2004) Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 136:1310–1322PubMedCrossRefGoogle Scholar
  24. 24.
    Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL, Racadot A, Proye C (1998) Hypocalcemia ­following thyroid surgery: incidence and prediction of ­outcome. World J Surg 22:718–724PubMedCrossRefGoogle Scholar
  25. 25.
    Walker Harris V, Jan De Beur S (2009) Postoperative hypoparathyroidism: medical and surgical therapeutic options. Thyroid 19:967–973CrossRefGoogle Scholar
  26. 26.
    Avenia N, Sanguinetti A, Cirocchi R, Docimo G, Ragusa M, Ruggiero R, Procaccini E, Boselli C, D’Ajello F, Barberini F, Parmeggiani D, Rosato L, Sciannameo F, De Toma G, Noya G (2009) Antibiotic prophylaxis in thyroid surgery: a preliminary multicentric Italian experience. Ann Surg Innov Res 5:10CrossRefGoogle Scholar
  27. 27.
    Toniato A, Boschin IM, Piotto A, Pelizzo M, Sartori P (2008) Thyroidectomy and parathyroid hormone: tracing hypocalcemia-prone patients. Am J Surg 196:285–288PubMedCrossRefGoogle Scholar
  28. 28.
    Bellantone R, Lombardi CP, Raffaelli M, Boscherini M, Alesina P, De Crea C, Traini E, Princi P (2002) Is routine supplementation therapy (calcium and vitamin D) useful after total thyroidectomy? Surgery 132:1109–1112PubMedCrossRefGoogle Scholar
  29. 29.
    AES Guidelines 06/01 Group (2007) Australian endocrine surgeons guidelines AES06/01. Postoperative parathyroid hormone measurement and early discharge after total thyroidectomy: analysis of Australian data and management recommendations. ANZ J Surg 77:199–202CrossRefGoogle Scholar
  30. 30.
    Wang TS, Cheung K, Roman SA, Sosa JA (2011) To supplement or not to supplement: a cost-utility analysis of calcium and vitamin D repletion in post-thyroidectomy patients. Ann Surg Oncol 18:1293–1299PubMedCrossRefGoogle Scholar
  31. 31.
    Burkey SH, van Heerden JA, Thompson GB, Grant CS, Schleck CD, Farley DR (2001) Reexploration for symptomatic hematomas after cervical exploration. Surgery 130:914–920PubMedCrossRefGoogle Scholar
  32. 32.
    Harding J, Sebag F, Sierra M, Palazzo FF, Henry JF (2006) Thyroid surgery: postoperative hematoma – prevention and treatment. Langenbecks Arch Surg 391:169–173PubMedCrossRefGoogle Scholar
  33. 33.
    Rosenbaum MA, Haridas M, McHenry CR (2008) Life-threatening neck hematoma complicating thyroid and parathyroid surgery. Am J Surg 195:339–343, discussion 343PubMedCrossRefGoogle Scholar
  34. 34.
    McHenry CR (1997) “Same-day” thyroid surgery: an analysis of safety, cost savings, and outcome. Am Surg 63:586–589, discussion 589–590PubMedGoogle Scholar
  35. 35.
    Spanknebel K, Chabot JA, DiGiorgi M, Cheung K, Lee S, Allendorf J, LoGerfo P (2005) Thyroidectomy using local anesthesia: a report of 1,025 cases over 16 years. J Am Coll Surg 201:375–385PubMedCrossRefGoogle Scholar
  36. 36.
    Snyder SK, Hamid KS, Roberson CR, Rai SS, Bossen AC, Luh JH, Scherer EP, Song J (2010) Outpatient thyroidectomy is safe and reasonable: experience with more than 1,000 planned outpatient procedures. J Am Coll Surg 210:575–582, 582–574PubMedCrossRefGoogle Scholar
  37. 37.
    Shaha AR (2006) Treatment of thyroid cancer based on risk groups. J Surg Oncol 94:683–691PubMedCrossRefGoogle Scholar
  38. 38.
    Hosking MP, Warner MA, Lobdell CM, Offord KP, Melton LJ 3rd (1989) Outcomes of surgery in patients 90 years of age and older. JAMA 261:1909–1915PubMedCrossRefGoogle Scholar
  39. 39.
    Bliss R, Patel N, Guinea A, Reeve TS, Delbridge L (1999) Age is no contraindication to thyroid surgery. Age Ageing 28:363–366PubMedCrossRefGoogle Scholar
  40. 40.
    Passler C, Avanessian R, Kaczirek K, Prager G, Scheuba C, Niederle B (2002) Thyroid surgery in the geriatric patient. Arch Surg 137:1243–1248PubMedCrossRefGoogle Scholar
  41. 41.
    Seybt MW, Khichi S, Terris DJ (2009) Geriatric thyroidectomy: safety of thyroid surgery in an aging population. Arch Otolaryngol Head Neck Surg 135:1041–1044PubMedCrossRefGoogle Scholar
  42. 42.
    Mekel M, Stephen AE, Gaz RD, Perry ZH, Hodin RA, Parangi S (2009) Thyroid surgery in octogenarians is associated with higher complication rates. Surgery 146:913–921PubMedCrossRefGoogle Scholar
  43. 43.
    Sosa JA, Mehta PJ, Wang TS, Boudourakis L, Roman SA (2008) A population-based study of outcomes from thyroidectomy in aging Americans: at what cost? J Am Coll Surg 206:1097–1105PubMedCrossRefGoogle Scholar
  44. 44.
    Jencks SF, Williams MV, Coleman EA (2009) Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 360:1418–1428PubMedCrossRefGoogle Scholar
  45. 45.
    Tuggle CT, Park LS, Roman S, Udelsman R, Sosa JA (2010) Rehospitalization among elderly patients with thyroid cancer after thyroidectomy are prevalent and costly. Ann Surg Oncol 17:2816–2823PubMedCrossRefGoogle Scholar
  46. 46.
    Sosa JA, Mehta PJ, Wang TS, Yeo HL, Roman SA (2007) Racial disparities in clinical and economic outcomes from thyroidectomy. Ann Surg 246:1083–1091PubMedCrossRefGoogle Scholar
  47. 47.
    Dinauer CA, Breuer C, Rivkees SA (2008) Differentiated thyroid cancer in children: diagnosis and management. Curr Opin Oncol 20:59–65PubMedCrossRefGoogle Scholar
  48. 48.
    Lee JA, Grumbach MM, Clark OH (2007) The optimal treatment for pediatric Graves’ disease is surgery. J Clin Endocrinol Metab 92:801–803PubMedCrossRefGoogle Scholar
  49. 49.
    Sosa JA, Tuggle CT, Wang TS, Thomas DC, Boudourakis L, Rivkees S, Roman SA (2008) Clinical and economic outcomes of thyroid and parathyroid surgery in children. J Clin Endocrinol Metab 93:3058–3065PubMedCrossRefGoogle Scholar
  50. 50.
    Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R (1998) The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 228:320–330PubMedCrossRefGoogle Scholar
  51. 51.
    Sosa JA, Wang TS, Yeo HL, Mehta PJ, Boudourakis L, Udelsman R, Roman SA (2007) The maturation of a specialty: workforce projections for endocrine surgery. Surgery 142:876–883PubMedCrossRefGoogle Scholar
  52. 52.
    Burge MR, Zeise TM, Johnsen MW, Conway MJ, Qualls CR (1998) Risks of complication following thyroidectomy. J Gen Intern Med 13:24–31PubMedCrossRefGoogle Scholar
  53. 53.
    Tuggle CT, Roman SA, Wang TS, Boudourakis L, Thomas DC, Udelsman R, Sosa JA (2008) Pediatric endocrine surgery: who is operating on our children? Surgery 144:869–877PubMedCrossRefGoogle Scholar
  54. 54.
    Harness JK, van Heerden JA, Lennquist S, Rothmund M, Barraclough BH, Goode AW, Rosen IB, Fujimoto Y, Proye C (2000) Future of thyroid surgery and training surgeons to meet the expectations of 2000 and beyond. World J Surg 24:976–982PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of Surgery, Division of Surgical OncologyMedical College of WisconsinMilwaukeeUSA
  2. 2.Sections of Oncological, Endocrine, and General SurgeryYale University School of MedicineNew HavenUSA

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