Avoidable reoperations for thyroid and parathyroid surgery: Effect of hospital volume

Mitchell, Jamie; Milas, Mira; Barbosa, Germán; Sutton, Jazmine; Berber, Eren; Siperstein, Allan

doi:10.1016/j.surg.2008.07.022

Cited by 92 publications

(56 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Nevertheless, our findings would further strengthen the conclusion of the BAETS audit where >50 thyroid surgical cases per year are required to achieve the lowest complication rates. Although there is no consistent definition of what constitutes ‘satisfactory' surgeon volume in thyroid surgery, our study findings add to the body of evidence supporting the association between surgeon volume and clinical outcome [1,2,3,4,7,13]. …”

Section: Discussionsupporting

confidence: 46%

Use of Pre-Ablation Radioiodine-131 Scan to Assess the Impact of Surgical Volume and Specialisation following Thyroidectomy for Differentiated Thyroid Carcinoma

et al. 2013

View full text Add to dashboard Cite

Background: We evaluated the relationship between thyroid remnant size following thyroidectomy for differentiated thyroid carcinoma and surgical volume and specialisation by assessing pre-ablation radioiodine-131 (¹³¹I) thyroid bed uptake (TBU) scanning as a surrogate for residual thyroid tissue. Methods: We analysed data of 651 patients in our thyroid cancer database. Patients' data were included if the following criteria were met: (1) diagnosis of differentiated thyroid carcinoma, (2) total or near-total thyroidectomy, (3) pre-ablation ¹³¹I scan prior to radioiodine ablation (RAI), (4) no distant metastasis, and (5) >3,000 MBq ablative dose of ¹³¹I. ¹³¹I diagnostic whole-body scans and measurement of thyroglobulin levels were carried out 3-9 months after RAI. 305 patients were included in the final analysis. Results: Four endocrine, 19 otolaryngology and 25 general surgeons performed thyroidectomies with median pre-ablation ¹³¹I TBU values of 1.0, 1.8 and 2.9%, respectively (p = 0.0031). There was a statistically significant relationship between number of thyroidectomies performed and median pre-ablation ¹³¹I TBU values up to the optimal number of 11 operations beyond which there was no further significant difference between surgeons. There were differences in remnant size between endocrine and general surgeons (p = 0.001), otolaryngology and general surgeons (p = 0.023) but not between endocrine and otolaryngology surgeons (p = 0.167). Conclusion: Using the pre-ablation ¹³¹I uptake scan as a surrogate for thyroid remnant quantification following thyroidectomy demonstrates the relationship between the surgical volume and size of thyroid remnant. The study also demonstrated beneficial effects of specialisation with specialist surgeons achieving the smallest thyroid remnant.

show abstract

Section: Discussionsupporting

confidence: 46%

Use of Pre-Ablation Radioiodine-131 Scan to Assess the Impact of Surgical Volume and Specialisation following Thyroidectomy for Differentiated Thyroid Carcinoma

et al. 2013

View full text Add to dashboard Cite

show abstract

“…In this context, few studies evaluated the impact of surgical expertise on parathyroid surgery in terms of number of patients referred to surgery, i.e. surgical volume (21,22,23). This parameter has been found to influence curative rate, operative failure and complications.…”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

Imaging of the parathyroid glands in primary hyperparathyroidism

Minisola¹,

Cipriani²,

Diacinti³

et al. 2016

European Journal of Endocrinology

View full text Add to dashboard Cite

Primary hyperparathyroidism (PHPT) is one of the most frequent endocrine diseases worldwide. Surgery is the only potentially curable option for patients with this disorder, even though in asymptomatic patients 50 years of age or older without end organ complications, a conservative treatment may be a possible alternative. Bilateral neck exploration under general anaesthesia has been the standard for the definitive treatment. However, significant improvements in preoperative imaging, together with the implementation of rapid parathyroid hormone determination, have determined an increased implementation of focused, minimally invasive surgical approach. Surgeons prefer to have a localization study before an operation (both in the classical scenario and in the minimally invasive procedure). They are not satisfied by having been referred a patient with just a biochemical diagnosis of PHPT. Imaging studies must not be utilized to make the diagnosis of PHPT. They should be obtained to both assist in determining disease etiology and to guide operative procedures together with the nuclear medicine doctor and, most importantly, with the surgeon. On the contrary, apart from minimally invasive procedures in which localization procedures are an obligate choice, some surgeons believe that literature on parathyroidectomy over the past two decades reveals a bias towards localization. Therefore, surgical expertise is more important than the search for abnormal parathyroid glands.

show abstract

“…1,15,16 Our overall cure rate in the reoperative setting was 89%. In comparison, our cure rate for initial minimally invasive parathyroidectomy MIP 5 minimally invasive parathyroidectomy; SCE 5 standard cervical exploration.…”

Section: Commentsmentioning

confidence: 83%

“…[1][2][3][4][5] Minimally invasive parathyroidectomyda focused, unilateral operation in selected patients with positive, concordant preoperative localization studies and an appropriate intraoperative parathyroid hormone drop after excision of a single adenomadhas become the standard initial operation for appropriate patients with primary hyperparathyroidism. Standard cervical (bilateral) exploration is used predominantly by 2 groups of surgeons: high-volume parathyroid surgeons who feel that standard cervical exploration is more efficacious than minimally invasive parathyroidectomy 6,7 and lower volume surgeons who are not trained in or do not have access to image-guided techniques.…”

mentioning

confidence: 99%

Fewer adverse events after reoperative parathyroidectomy associated with initial minimally invasive parathyroidectomy

Morris

Lee

Warneke

et al. 2014

The American Journal of Surgery

View full text Add to dashboard Cite

Avoidable reoperations for thyroid and parathyroid surgery: Effect of hospital volume

Cited by 92 publications

References 15 publications

Use of Pre-Ablation Radioiodine-131 Scan to Assess the Impact of Surgical Volume and Specialisation following Thyroidectomy for Differentiated Thyroid Carcinoma

Use of Pre-Ablation Radioiodine-131 Scan to Assess the Impact of Surgical Volume and Specialisation following Thyroidectomy for Differentiated Thyroid Carcinoma

Imaging of the parathyroid glands in primary hyperparathyroidism

Fewer adverse events after reoperative parathyroidectomy associated with initial minimally invasive parathyroidectomy

Contact Info

Product

Resources

About