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A national analysis of trends, outcomes and volume-outcomes relationships in thyroid surgery

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Title: A national analysis of trends, outcomes and volume-outcomes relationships in thyroid surgery
Authors: Nouraei, SA
Virk, JS
Middleton, SE
Aylin, P
Mace, A
Vaz, F
Kaddour, H
Darzi, A
Tolley, NS
Item Type: Journal Article
Abstract: OBJECTIVES: Thyroid conditions are common and their incidence is increasing. Surgery is the mainstay treatment for many thyroid conditions, and understanding its utilisation trends and morbidity are central to improving patient care. DESIGN: An N=near-all analysis of the English administrative dataset to identify trends in thyroid surgery specialisation, volume-outcome relationships, and the incidence and risk factors for short- and long-term morbidity. MAIN OUTCOME MEASURES: Between 2004 and 2012, 72594 patients underwent elective thyroidectomy in England. Information about age, sex, morbidities, thyroid disease and surgery, adjuvant treatments, and complications including hypocalcaemia and vocal palsy were recorded. RESULTS: Mean age at surgery was 49±30 and a female predominance (82%) was observed. Most patients underwent hemithyroidectomy (51%) or total thyroidectomy (32%). Patients underwent surgery for benign (52.5%), benign inflammatory (21%), and malignant (17%) thyroid diseases. Thyroid surgery grew by 2.9% a year and increased in specialization. Increased surgeon volume significantly reduced lengths of stay: the proportion of length of stay outliers fell from 11.8% for patients of occasional thyroidectomists (<5 per year) to 2.8% for patients of high-volume surgeons (>50 thyroidectomies a year). Post-discharge vocal palsy and hypocalcaemia occurred in 1.87% and 1.58% of cases respectively. High-volume surgeons had a reduced incidence of vocal palsy and volumes >30 were consistently protective. CONCLUSIONS: Thyroid surgery is increasingly specialised. High-volume surgeons achieve lower complications rates, including lower vocal palsy rates, and length of stay. This article is protected by copyright. All rights reserved.
Issue Date: 20-Aug-2016
Date of Acceptance: 15-Aug-2016
URI: http://hdl.handle.net/10044/1/41741
DOI: https://dx.doi.org/10.1111/coa.12730
ISSN: 1749-4486
Publisher: Wiley
Start Page: 354
End Page: 365
Journal / Book Title: Clinical Otolaryngology
Volume: 42
Issue: 2
Copyright Statement: © 2016 John Wiley & Sons Ltd. This is the accepted version of the following article: "A national analysis of trends, outcomes and volume–outcome relationships in thyroid surgery", which has been published in final form at http://dx.doi.org/10.1111/coa.12730.
Sponsor/Funder: Imperial College Healthcare NHS Trust
National Institute for Health Research (NIHR)
Dr Foster Intelligence
Funder's Grant Number: RDPSC 79560
RDPSC 79560
N/A
Keywords: Science & Technology
Life Sciences & Biomedicine
Otorhinolaryngology
CANCER INCIDENCE
MANAGEMENT
ULTRASOUND
IMPACT
1103 Clinical Sciences
Publication Status: Published
Appears in Collections:Division of Surgery
Faculty of Medicine
Epidemiology, Public Health and Primary Care



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