People who have to undergo a thyroidectomy, a surgical procedure that involves removing the thyroid gland, can reduce their risk of complications by choosing doctors who perform more than 25 procedures per year, a new study found.
The researchers at Duke Health wanted to examine whether a doctor's experience with thyroidectomies affected patient outcomes. The team pointed out that even though this operation is very common, about 51 percent of surgeons performed this type of surgery only once a year.
"This is a very technical operation, and patients should feel empowered to ask their surgeons how many procedures they do each year, on average," said Dr. Julie A. Sosa, the chief of endocrine surgery at Duke.
For the study, the researchers looked at data of 16,954 patients and 4,627 surgeons taken from the Health Care Utilization Project database. All of the patients had a thyroidectomy from 1998 to 2009. The researchers reported that overall, thyroidectomies were considered to be a very safe procedure. However, the researchers did manage to find an association between the number of thyroidectomies a surgeon performed per year and risk of complications for the patient.
Patients who went to doctors who performed less than 25 thyroidectomies per year were 1.5 times more likely to have complications. The researchers found that risk of complications declined as the number of thyroidectomy cases increased. For example, patients who saw a doctor who performed just one thyroidectomy per year had an 87 percent increased risk of complications. This risk fell to 22 percent in patients who chose a doctor with 11 to 15 cases per year. Risk of complications leveled out at an average of 25 thyroidectomies per year.
Complications from a thyroidectomy included bleeding, issues with the parathyroid glands and damage to the laryngeal nerve, which can affect how a patient speaks, breathes and swallows. The researchers said that regardless of the severity of the complication, any kind can drive up medical cost and lower quality of life.
"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," Sosa said. "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."
The study was published in the journal Annals of Surgery.
