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Mathur A, Patel KN, Wilhelm SM, Sippel RS, Miller BS, Solórzano CC, Kelz R. What constitutes quality in endocrine surgery? Statement from the American Association of Endocrine Surgeons. Surgery 2024:S0039-6060(24)00214-9. [PMID: 38762381 DOI: 10.1016/j.surg.2024.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Aarti Mathur
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kepal N Patel
- Department of Surgery, NYU Langone Health, New York, NY
| | - Scott M Wilhelm
- University Hospitals, Cleveland Medical Center, Cleveland, OH
| | | | - Barbra S Miller
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Carmen C Solórzano
- Department of Surgery-Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University, Nashville, TN
| | - Rachel Kelz
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania and Perelman School of Medicine, Philadelphia, PA
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Wright K, Squires S, Cisco R, Trickey A, Kebebew E, Suh I, Seib CD. Disparities in access to high-volume parathyroid surgeons in the United States: A call to action. Surgery 2024; 175:48-56. [PMID: 37940435 PMCID: PMC10942749 DOI: 10.1016/j.surg.2023.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/13/2023] [Accepted: 03/30/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Parathyroidectomy by a high-volume surgeon is associated with a reduced risk of perioperative complications and of failure to cure primary and secondary hyperparathyroidism. There are limited data on disparities in access to high-volume parathyroid surgeons in the United States. METHODS We used publicly available 2019 Medicare Provider Utilization and Payment data to identify all surgeons who performed >10 parathyroidectomies for Medicare fee-for-service beneficiaries, anticipating that fee-for-service beneficiaries likely represent only a subset of their high-volume practices. High-volume parathyroid surgeon characteristics and geographic distribution were evaluated. Inequality in the distribution of surgeons was measured by the Gini coefficient. The association between neighborhood disadvantage, based on the Area Deprivation Index, and proximity to high-volume parathyroid surgeons was evaluated using a one-way analysis of variance with Bonferroni-corrected pairwise comparisons. A sensitivity analysis was performed restricting to high-volume parathyroid surgeons within each hospital referral region, evidence-based regional markets for tertiary medical care. RESULTS We identified 445 high-volume parathyroid surgeons who met inclusion criteria with >10 parathyroidectomies for Medicare fee-for-service beneficiaries. High-volume parathyroid surgeons were 71% male sex, and 59.8% were general surgeons. High-volume parathyroid surgeons were more likely to practice in a Metropolitan Statistical Area with a population >1 million than in less populous metropolitan or rural areas. The number of high-volume parathyroid surgeons per 100,000 fee-for-service Medicare beneficiaries in the 53 most populous Metropolitan Statistical Areas ranged from 0 to 4.94, with the highest density identified in Salt Lake City, Utah. In 2019, 50% of parathyroidectomies performed by high-volume parathyroid surgeons were performed by 20% of surgeons in this group, suggesting unequal distribution of surgical care (Gini coefficient 0.41). Patients in disadvantaged neighborhoods were farther from high-volume parathyroid surgeons than those in advantaged neighborhoods (median distance: disadvantaged 27.8 miles, partially disadvantaged 20.7 miles, partially advantaged 12.1 miles, advantaged 8.4 miles; P < .001). This association was also shown in the analysis of distance to high-volume parathyroid surgeons within the hospital referral region (P < .001). CONCLUSION Older adults living in disadvantaged neighborhoods have less access to high-volume parathyroid surgeons, which may adversely affect treatment and outcomes for patients with primary and secondary hyperparathyroidism. This disparity highlights the need for actionable strategies to provide equitable access to care, including improved regionalization of high-volume parathyroid surgeon services and easing travel-related burdens for underserved patients.
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Affiliation(s)
- Kyla Wright
- Department of Surgery, New York University Grossman School of Medicine, New York, NY
| | | | - Robin Cisco
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Amber Trickey
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Electron Kebebew
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Insoo Suh
- Department of Surgery, New York University Grossman School of Medicine, New York, NY
| | - Carolyn D Seib
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA; Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Palo Alto, CA; Division of General Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA.
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3
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Gao TP, Green RL, Kuo LE. Disparities in Access to High-Volume Surgeons and Specialized Care. Endocrinol Metab Clin North Am 2023; 52:689-703. [PMID: 37865482 DOI: 10.1016/j.ecl.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
The significant volume-outcome relationship has triggered interest in improving quality of care by directing patients to high-volume centers and surgeons. However, significant disparities exist for different racial/ethnic, geographic, and socioeconomic groups for thyroid, parathyroid, adrenal, and pancreatic neuroendocrine surgical diseases disease.
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Affiliation(s)
- Terry P Gao
- Department of General Surgery, Temple University Hospital, 3401 North Broad Street, Zone C, 4th Floor, Philadelphia, PA 19140, USA
| | - Rebecca L Green
- Department of General Surgery, Temple University Hospital, 3401 North Broad Street, Zone C, 4th Floor, Philadelphia, PA 19140, USA
| | - Lindsay E Kuo
- Department of General Surgery, Temple University Hospital, 3401 North Broad Street, Zone C, 4th Floor, Philadelphia, PA 19140, USA.
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Adil EA, Francisco S, Morgan E, Kawai K, Cunningham MJ. Juvenile Nasopharyngeal Angiofibroma: Outcomes Analysis Based Upon Hospital Volume. Laryngoscope 2023; 133:3216-3220. [PMID: 36896888 DOI: 10.1002/lary.30640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/06/2023] [Accepted: 02/21/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To evaluate the management of juvenile nasopharyngeal angiofibroma (JNA) from a national perspective with outcomes comparison based on hospital volume. STUDY DESIGN Ten-year Pediatric Health Information Systems (PHIS) data analysis. METHODS The PHIS database was queried for the diagnosis of JNA. Data regarding demographics, surgical approach, embolization, length of stay, charges, readmission, and revision surgery was collected and analyzed. Hospitals were classified as low volume if fewer than 10 cases and high volume if greater than or equal to 10 cases during the study period. A random effects model compared outcomes based on hospital volume. RESULTS A total of 287 JNA patients were identified with a mean age of 13.8 (± 2.7) years. Nine hospitals were classified as high volume, accounting for a total of 121 patients. The mean length of hospitalization, blood transfusion rate, and 30-day readmissions did not differ significantly by hospital volume. Patients cared for at high-volume institutions were less likely to require postoperative mechanical ventilation (8.3% vs. 25.0%; adjusted RR = 0.32; 95% CI 0.14-0.73; p < 0.01) or return to the operating room for residual disease than patients admitted to low-volume hospitals (7.4% vs. 20.5%; adjusted RR = 0.38; 95% CI 0.18-0.79; p = 0.01). CONCLUSIONS The management of JNA is complex from both an operative and perioperative management standpoint. Over the past decade, nearly half (42.2%) of JNA patients have been managed at nine institutions in the United States. These centers have significantly lower rates of postoperative mechanical ventilation and the need for revision surgery. LEVEL OF EVIDENCE 3 Laryngoscope, 133:3216-3220, 2023.
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Affiliation(s)
- Eelam A Adil
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Francisco
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Ella Morgan
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael J Cunningham
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Watanabe A, Wiseman SM. Quality indicators for thyroid cancer care: What should surgeons know? Am J Surg 2023; 225:1108-1110. [PMID: 36792454 DOI: 10.1016/j.amjsurg.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/13/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Affiliation(s)
- Akie Watanabe
- Department of Surgery, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Sam M Wiseman
- Department of Surgery, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.
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Gray WK, Navaratnam AV, Rennie C, Mendoza N, Briggs TWR, Phillips N. The volume-outcome relationship for endoscopic transsphenoidal pituitary surgery for benign neoplasm: analysis of an administrative dataset for England. Br J Neurosurg 2023:1-8. [PMID: 36740733 DOI: 10.1080/02688697.2023.2175783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/23/2023] [Accepted: 01/28/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Setting minimum annual volume thresholds for pituitary surgery in England is seen as one way of improving outcomes for patients and service efficiency. However, there are few recent studies from the UK on whether a volume-outcome effect exists, particularly in the era of endoscopic surgery. Such data are needed to allow evidence-based decision making. The aim of this study was to use administrative data to investigate volume-outcome effects for endoscopic transsphenoidal pituitary surgery in England. METHODS Data from the Hospital Episodes Statistics database for adult endoscopic transsphenoidal pituitary surgery for benign neoplasm conducted in England from April 2013 to March 2019 (inclusive) were extracted. Annual surgeon and trust volume was defined as the number of procedures conducted in the 12 months prior to the index procedure. Volume was categorised as < 10, 10-19, 20-29, 30-39 and ≥40 procedures for surgeon volume and < 20, 20-39, 40-59, 60-79 and ≥80 procedures for trust volume. The primary outcome was repeat ETSPS during the index procedure or during a hospital admission within one-year of discharge from the index procedure. RESULTS Data were available for 4590 endoscopic transsphenoidal pituitary procedures. After adjustment for covariates, higher surgeon volume was significantly associated with reduced risk of repeat surgery within one year (odds ratio (OR) 0.991 (95% confidence interval (CI) 0.982-1.000)), post-procedural haemorrhage (OR 0.977 (95% CI 0.967-0.987)) and length of stay greater than the median (0.716 (0.597-0.859)). A higher trust volume was associated with reduced risk of post-procedural haemorrhage (OR 0.992 (95% CI 0.985-0.999)), but with none of the other patient outcomes studied. CONCLUSIONS A surgeon volume-outcome relationship exists for endoscopic transsphenoidal pituitary surgery in England.
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Affiliation(s)
| | - Annakan V Navaratnam
- NHS England and NHS Improvement, London, UK
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Catherine Rennie
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Nigel Mendoza
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | - Nick Phillips
- NHS England and NHS Improvement, London, UK
- Leeds General Infirmary, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Surgeon experience in glioblastoma surgery of the elderly-a multicenter, retrospective cohort study. J Neurooncol 2023; 161:563-572. [PMID: 36719614 PMCID: PMC9992256 DOI: 10.1007/s11060-023-04252-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 01/25/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE To assess the impact of individual surgeon experience on overall survival (OS), extent of resection (EOR) and surgery-related morbidity in elderly patients with glioblastoma (GBM), we performed a retrospective case-by-case analysis. METHODS GBM patients aged ≥ 65 years who underwent tumor resection at two academic centers were analyzed. The experience of each neurosurgeon was quantified in three ways: (1) total number of previously performed glioma surgeries (lifetime experience); (2) number of surgeries performed in the previous five years (medium-term experience) and (3) in the last two years (short-term experience). Surgeon experience data was correlated with survival (OS) and surrogate parameters for surgical quality (EOR, morbidity). RESULTS 198 GBM patients (median age 73.0 years, median preoperative KPS 80, IDH-wildtype status 96.5%) were included. Median OS was 10.0 months (95% CI 8.0-12.0); median EOR was 89.4%. Surgery-related morbidity affected 19.7% patients. No correlations of lifetime surgeon experience with OS (P = .693), EOR (P = .693), and surgery-related morbidity (P = .435) were identified. Adjuvant therapy was associated with improved OS (P < .001); patients with surgery-related morbidity were less likely to receive adjuvant treatment (P = .002). In multivariable testing, adjuvant therapy (P < .001; HR = 0.064, 95%CI 0.028-0.144) remained the only significant predictor for improved OS. CONCLUSION Less experienced neurosurgeons achieve similar surgical results and outcome in elderly GBM patients within the setting of academic teaching hospitals. Adjuvant treatment and avoidance of surgery-related morbidity are crucial for generating a treatment benefit for this cohort.
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Abiri A, Pang JC, Roman K, Goshtasbi K, Birkenbeuel JL, Kuan EC, Tjoa T, Haidar YM. Facility Volume as a Prognosticator of Survival in Locally Advanced Papillary Thyroid Cancer. Laryngoscope 2023; 133:443-450. [PMID: 35822421 PMCID: PMC9837308 DOI: 10.1002/lary.30280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/26/2022] [Accepted: 06/13/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate the influence of facility case-volume on survival in patients with locally advanced papillary thyroid cancer (PTC), and to identify prognostic case-volume thresholds for facilities managing this patient population. STUDY DESIGN Retrospective database study. METHODS The 2004-2017 National Cancer Database was queried for patients receiving definitive surgery for locally advanced PTC. Using K-means clustering and multivariable Cox proportional-hazards (CPH) regression, two groups with distinct spectrums of facility case-volumes were generated. Multivariable CPH regression and Kaplan-Meier analysis assessed for the influence of facility case-volume and the prognostic value of its stratification on overall survival (OS). RESULTS Of 48,899 patients treated at 1304 facilities, there were 34,312 (70.2%) females and the mean age was 48.0 ± 16.0 years. Increased facility volume was significantly associated with reduced all-cause mortality (HR 0.996; 95% CI, 0.992-0.999; p = 0.008). Five facility clusters were generated, from which two distinct cohorts were identified: low (LVF; <27 cases/year) and high (HVF; ≥27 cases/year) facility case-volume. Patients at HVFs were associated with reduced mortality compared to those at LVFs (HR 0.791; 95% CI, 0.678-0.923, p = 0.003). Kaplan-Meier analysis of propensity score-matched N0 and N1 patients demonstrated higher OS in HVF cohorts (all p < 0.001). CONCLUSIONS Facility case-volume was an independent predictor of improved OS in locally advanced PTC, indicating a possible survival benefit at high-volume medical centers. Specifically, independent of a number of sociodemographic and clinical factors, facilities that treated ≥27 cases per year were associated with increased OS. Patients with locally advanced PTC may, therefore, benefit from referrals to higher-volume facilities. LEVEL OF EVIDENCE 4 Laryngoscope, 133:443-450, 2023.
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Affiliation(s)
- Arash Abiri
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Jonathan C Pang
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Kelsey Roman
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Jack L Birkenbeuel
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Tjoson Tjoa
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
| | - Yarah M Haidar
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, U.S.A
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Rajan S, Gracie D, Aspinall S. Does Surgeon Volume Impact Morbidity Following Parathyroidectomy? A Study of 16,140 Parathyroidectomies from the UK Registry of Endocrine and Thyroid Surgery (UKRETS) Database. World J Surg 2023; 47:1221-1230. [PMID: 36593341 DOI: 10.1007/s00268-022-06863-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Outcomes in endocrine surgery have been shown to improve with surgeon volume. We aimed to study the effect of surgeon volume on morbidity following parathyroidectomy. METHODS UKRETS data from 2004 to 2019 was studied. Parathyroidectomies for primary hyperparathyroidism with complete data were included. Exclusion criteria were age <18 or >80 years; surgeons contributing <10 cases overall; and length of stay >28 days. Multivariable analysis was performed. Primary outcome was persistent hypercalcaemia; secondary outcomes were haemorrhage, length of stay, need for re-admission, post-operative hypocalcaemia, and need for calcium/vitamin D supplements to maintain eucalcaemia at 6 months. RESULTS 153 surgeons undertook mean 22.5 (median 17, range 2-115) parathyroidectomies/year. Persistent hypercalcaemia affected 4.8% (776/16140) overall; 5.7% (71/1242) in surgeons undertaking < 10 cases/year; 5.1% (3339/6617) for 10-30 cases/year; 5.0% (270/5397) for 30-50 cases; and 3.3% (96/2884) for >50 cases/year. High-volume (>50 parathyroidectomies/year) surgeons operated 23.4% (809/3464) of negative localisation cases compared to 16.4% (2074/12676) of positive localisation cases. Persistent hypercalcaemia was almost twice as common in image negative (7.9%) compared to image-positive (4%) cases. Persistent hypercalcaemia was significantly more likely to occur in the low volume (<10 parathyroidectomies/year) group than high volume (>50 parathyroidectomies/year), regardless of image positivity (p = 0.0006). Surgeon volume significantly reduced persistent hypercalcaemia on multivariable analysis (OR = 0.878, 95%CI 0.842-0.914, p < 0.001), along with age, sex, and positive localisation. BNE and re-operation significantly increased persistent hypercalcaemia. Post-operative hypocalcaemia occurred in 3.2% (509/16040) and was reduced with increasing surgeon volume (OR = 0.951, 95%CI 0.910-0.993, p < 0.001). Haemorrhage and length of stay were not significantly associated with surgeon volume. CONCLUSION The incidence of persistent hypercalcaemia, post-operative hypocalcaemia, and persistent hypoparathyroidism decreased with increasing surgeon volume. The relative reduction in persistent hypercalcaemia with surgeon volume was similar in image negative and positive groups, but the absolute reduction was higher in image negative cases. Restricting image negative parathyroidectomy to high-volume surgeons could be considered.
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Affiliation(s)
- Sendhil Rajan
- General and Endocrine Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN, UK
| | - Dale Gracie
- Paediatric Surgery, Royal Hospital of Children and Young People, Edinburgh, UK
| | - Sebastian Aspinall
- General and Endocrine Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, AB25 2ZN, UK.
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Gray WK, Navaratnam AV, Day J, Wass JAH, Briggs TWR, Lansdown M. Volume-Outcome Associations for Parathyroid Surgery in England: Analysis of an Administrative Data Set for the Getting It Right First Time Program. JAMA Surg 2022; 157:581-588. [PMID: 35507350 PMCID: PMC9069339 DOI: 10.1001/jamasurg.2022.1353] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Previous studies have suggested an association between surgical volume and patient outcomes for parathyroid surgery. However, most previous studies are relatively small and the literature is dominated by studies form the US, which might not be readily generalizable to other settings. Objective To investigate volume-outcome associations for parathyroid surgery in England. Design, Setting, and Participants Cohort study that included all National Health Service hospital trusts in England with secondary analysis of administrative data using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10). Participants included all adult, elective hospital admissions for parathyroid surgery without a diagnosis of multiple endocrine neoplasia, parathyroid cancer, or kidney disease over a 5-year period (April 2014-March 2019 inclusive). Exposures The number of procedures conducted in the year prior to the index procedure by each surgeon and each hospital trust. Main Outcomes and Measures Repeat parathyroid surgery within 1 year of the index procedure. Results This study included data for 17 494 participants who underwent parathyroidectomies conducted across 125 hospital trusts. The median (IQR) age of patients was 62 (53-71) years, and 13 826 were female (79.0%). Across the period, the number of surgeons conducting parathyroid surgery changed little (280 in 2014-2015 and 2018-2019), although the number of procedures conducted rose from 3331 to 3848 per annum. Repeat parathyroid surgery at 1 year was significantly associated with surgeon volume (odds ratio [OR], 0.99; 95% CI, 0.98-0.99), but not trust volume, in the previous 12 months. Extended length of stay (OR, 0.98; 95% CI, 0.98-0.99), hypoparathyroidism/calcium disorder (OR, 1.0; 95% CI, 0.99-1.0), and postprocedural complications (OR, 0.99; 95% CI, 0.99-1.0) were also associated with lower surgeon volume. Conclusions and Relevance In this cohort study, higher surgeon annual volume was associated with decreased rates of repeat parathyroid surgery. A minimum volume threshold of 20 procedures per annum should improve patient outcomes, although possible negative effects on access to services should be monitored.
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Affiliation(s)
- William K Gray
- Getting It Right First Time program, National Health Service England and National Health Service Improvement, London, United Kingdom
| | - Annakan V Navaratnam
- Getting It Right First Time program, National Health Service England and National Health Service Improvement, London, United Kingdom.,University College London Hospitals, National Health Service Foundation Trust, London, United Kingdom
| | - Jamie Day
- Getting It Right First Time program, National Health Service England and National Health Service Improvement, London, United Kingdom
| | - John A H Wass
- Getting It Right First Time program, National Health Service England and National Health Service Improvement, London, United Kingdom.,Endocrinology Department, Oxford University, Churchill Hospital, Oxford, United Kingdom
| | - Tim W R Briggs
- Getting It Right First Time program, National Health Service England and National Health Service Improvement, London, United Kingdom
| | - Mark Lansdown
- Getting It Right First Time program, National Health Service England and National Health Service Improvement, London, United Kingdom.,St James's University Hospital, Leeds Teaching Hospitals, National Health Service Trust, Leeds, United Kingdom
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Wang R, Abraham P, Lindeman B, Chen H, Fazendin J. Is preoperative parathyroid localization necessary for tertiary hyperparathyroidism? Am J Surg 2022; 224:918-922. [DOI: 10.1016/j.amjsurg.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 12/15/2022]
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12
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Perigli G, Cianchi F, Giudici F, Russo E, Fiorenza G, Petrone L, Sparano C, Staderini F, Badii B, Morandi A. Thyroidectomy for Cancer: The Surgeon and the Parathyroid Glands Sparing. J Clin Med 2021; 10:jcm10194323. [PMID: 34640352 PMCID: PMC8509338 DOI: 10.3390/jcm10194323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The diagnosis of thyroid cancer is continuously increasing and consequently the amount of thyroidectomy. Notwithstanding the actual surgical skill, postoperative hypoparathyroidism still represents its most frequent complication. The aims of the present study are to analyze the rate of postoperative hypoparathyroidism after thyroidectomy, performed for cancer by a single first operator, without any technological aid, and to compare the data to those obtained adopting the most recent technological adjuncts developed to reduce the postoperative hypoparathyroidism. METHODS During the period 1997-2020 at the Endocrine Surgery Unit of the Department of Clinical and Experimental Medicine of the University of Florence, 1648 consecutive extracapsular thyroidectomies for cancer (401 with central compartment node dissection) were performed. The percentage of hypoparathyroidism, temporary or permanent, was recorded both in the first period (Group A) and in the second, most recent period (Group B). Total thyroidectomies were compared either with those with central compartment dissection and lobectomies. Minimally invasive procedures (MIT, MIVAT, some transoral) were also compared with conventional. Fisher's exact and Chi-square tests were used for comparison of categorical variables. p < 0.01 was considered statistically significant. Furthermore, a literature research from PubMed® has been performed, considering the most available tools to better identify parathyroid glands during thyroidectomy, in order to reduce the postoperative hypoparathyroidism. We grouped and analyzed them by technological affinity. RESULTS On the 1648 thyroidectomies enrolled for the study, the histotype was differentiated in 93.93 % of cases, medullary in 4% and poorly differentiated in the remaining 2.06%. Total extracapsular thyroidectomy and lobectomy were performed respectively in 95.45% and 4.55%. We recorded a total of 318 (19.29%) cases of hypocalcemia, with permanent hypoparathyroidism in 11 (0.66%). In regard to the literature, four categories of tools to facilitate the identification of the parathyroids were identified: (a) vital dye; (b) optical devices; (c) autofluorescence of parathyroids; and (d) autofluorescence enhanced by contrast media. Postoperative hypoparathyroidism had a variable range in the different groups. CONCLUSIONS Our data confirm that the incidence of post-surgical hypoparathyroidism is extremely low in the high volume centers. Its potential reduction adopting technological adjuncts is difficult to estimate, and their cost, together with complexity of application, do not allow immediate routine use. The trend towards increasingly unilateral surgery in thyroid carcinoma, as confirmed by our results in case of lobectomy, is expected to really contribute to a further reduction of postsurgical hypoparathyroidism.
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Affiliation(s)
- Giuliano Perigli
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Fabio Cianchi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Francesco Giudici
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
- Correspondence:
| | - Edda Russo
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Giulia Fiorenza
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Luisa Petrone
- Department of Biomedical, Experimental and Clinical Sciences Mario Serio, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (L.P.); (C.S.)
| | - Clotilde Sparano
- Department of Biomedical, Experimental and Clinical Sciences Mario Serio, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (L.P.); (C.S.)
| | - Fabio Staderini
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Benedetta Badii
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
| | - Alessio Morandi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 6, 50135 Florence, Italy; (G.P.); (F.C.); (E.R.); (G.F.); (F.S.); (B.B.); (A.M.)
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