Surgeon volume and hospital volume in endocrine neck surgery: how many procedures are needed for reaching a safety level and acceptable costs? A systematic narrative review

Melfa, Giuseppina

doi:10.11138/gchir/2018.39.1.005

Cited by 41 publications

(26 citation statements)

References 36 publications

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“…All patients with complete clinical reports regarding preparation for surgery, hospital course and follow-up until 30 June 2021 were included in the study; patients included underwent surgery for PTCs with metastases to the lateral-cervical lymph nodes at the time of surgery and who, therefore, underwent TT + CND + unilateral LND in one step. Surgical procedures were performed by surgeons, belonging to the respective operating units, classifiable as “high volume” according to the unanimous consensus of the international literature [ 17 , 18 ], having all performed over 1000 thyroidectomies with more than 100 procedures/year for a period of activity of 10 or more years.…”

Section: Methodsmentioning

confidence: 99%

Predictors of Central Compartment Involvement in Patients with Positive Lateral Cervical Lymph Nodes According to Clinical and/or Ultrasound Evaluation

Graceffa

Orlando

Cocorullo

et al. 2021

JCM

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Lymph node neck metastases are frequent in papillary thyroid carcinoma (PTC). Current guidelines state, on a weak level of evidence, that level VI dissection is mandatory in the presence of latero-cervical metastases. The aim of our study is to evaluate predictive factors for the absence of level VI involvement despite the presence of metastases to the lateral cervical stations in PTC. Eighty-eight patients operated for PTC with level II–V metastases were retrospectively enrolled in the study. Demographics, thyroid function, autoimmunity, nodule size and site, cancer variant, multifocality, Bethesda and EU-TIRADS, number of central and lateral lymph nodes removed, number of positive lymph nodes and outcome were recorded. At univariate analysis, PTC location and number of positive lateral lymph nodes were risk criteria for failure to cure. ROC curves demonstrated the association of the number of positive lateral lymph nodes and failure to cure. On multivariate analysis, the protective factors were PTC located in lobe center and number of positive lateral lymph nodes < 4. Kaplan–Meier curves confirmed the absence of central lymph nodes as a positive prognostic factor. In the selected cases, Central Neck Dissection (CND) could be avoided even in the presence of positive Lateralcervical Lymph Nodes (LLN+).

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Section: Methodsmentioning

confidence: 99%

Predictors of Central Compartment Involvement in Patients with Positive Lateral Cervical Lymph Nodes According to Clinical and/or Ultrasound Evaluation

Graceffa

Orlando

Cocorullo

et al. 2021

JCM

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“…Some differences in outcomes between these investigated categories were underlined: best results of the high-volume surgeon were evident especially in terms of complications, and on the contrary, best outcomes of a high-volume center were mainly economics, such as lower hospital stay and general costs of the procedures. A cut-off of 35–40 thyroidectomies per year for single surgeon appears reasonable for identifying an adequate high-volume practice [ 16 ] (ELIII, RGD).…”

Section: Resultsmentioning

confidence: 99%

“…Minimum hospital volume needed for reaching a satisfying level of safety is less clear and ranges from 20 to 200 thyroid operations per year in published series. However, a cut-off of 90–100 thyroidectomies for a single center appears reasonable for identifying an adequate high-volume practice [ 16 ] (ELIII, RGD).…”

Section: Resultsmentioning

confidence: 99%

“…The results of the analysis were presented and discussed at the 8th Conference of the European Society of Endocrine Surgeons (ESES), "Volumes, Outcomes, and Quality Standards in Endocrine Surgery" (Granada, Spain, May [16][17][18]2019). This paper incorporates the results of the analysis of the literature and the outcomes of the discussions.…”

Section: Introductionmentioning

confidence: 99%

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Volume, outcomes, and quality standards in thyroid surgery: an evidence-based analysis—European Society of Endocrine Surgeons (ESES) positional statement

Lorenz

Raffaelli

Barczyński

et al. 2020

Langenbecks Arch Surg

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Introduction Continuous efforts in surgical speciality aim to improve outcome. Therefore, correlation of volume and outcome, developing subspecialization, and identification of reliable parameters to identify and measure quality in surgery gain increasing attention in the surgical community as well as in public health care systems, and by health care providers. The need to investigate these correlations in the area of endocrine surgery was identified by ESES, and thyroid surgery was chosen for this analysis of the prevalent literature with regard to outcome and volume. Materials and methods A literature search that is detailed below about correlation between volume and outcome in thyroid surgery was performed and assessed from an evidence-based perspective. Following presentation and live data discussion, a revised final positional statement was presented and consented by the ESES assembly. Results There is a lack of prospective randomized controlled studies for all items representing quality parameters of thyroid surgery using uniform definitions. Therefore, evidence levels are low and recommendation grades are based mainly on expert and peer evaluation of the prevalent data. Conclusion In thyroid surgery a volume and outcome relationship exists with respect to the prevalence of complications. Besides volume, cumulative experience is expected to improve outcomes. In accordance with global data, a case load of < 25 thyroidectomies per surgeon per year appears to identify a low-volume surgeon, while > 50 thyroidectomies per surgeon per year identify a high-volume surgeon. A center with a case load of > 100 thyroidectomies per year is considered high-volume. Thyroid cancer and autoimmune thyroid disease predict an increased risk of surgical morbidity and should be operated by high-volume surgeons. Oncological results of thyroid cancer surgery are significantly better when performed by high-volume surgeons.

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“…18-21 Building a high-volume endocrine surgery practice, as defined by performing 25 to 40 endocrine surgeries per year, can be particularly challenging once already in practice, particularly for surgeons practicing in a competitive environment. 22,23…”

Section: Discussionmentioning

confidence: 99%

In‐Practice Endocrine Surgery Fellowship: A Novel Training Model

Tierney

Eldeiry²,

Garber³

et al. 2020

Otolaryngol.--head neck surg.

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Objective Endocrine surgery is an expanding field within otolaryngology. We hypothesized that a novel endocrine surgery fellowship model for in-practice otolaryngologists could result in expert-level training. Study Design Qualitative clinical study with chart review. Setting Urban community practice and academic medical center. Methods Two board-certified general otolaryngologists collaborated with a senior endocrine surgeon to increase their endocrine surgery expertise between March 2015 and December 2017. The senior surgeon provided intensive surgical training to both surgeons for all of their endocrine surgeries. Both parties collaborated with endocrinology to coordinate medical care and receive referrals. All patients undergoing endocrine surgery during this time frame were reviewed retrospectively. Results A total of 235 endocrine surgeries were performed. Of these, 198 thyroid surgeries were performed, including 98 total thyroidectomies (48%), 90 lobectomies (45%), and 10 completion thyroidectomies (5%). Sixty cases demonstrated papillary thyroid carcinoma, 11 follicular thyroid carcinoma, and 4 medullary thyroid carcinoma. Neck dissections were performed in 14 of the cases. Thirty-seven parathyroid explorations were performed. There were no reports of permanent hypoparathyroidism. Thirteen patients (5.5%) developed temporary hypoparathyroidism. Six patients (2.5%) developed postoperative seroma. Three patients (1.3%) developed postoperative hematomas requiring reoperation. One patient (0.4%) developed permanent vocal fold paralysis, and 3 patients (1.3%) had temporary dysphonia. Thirty-five of 37 (94.5%) parathyroid explorations resulted in biochemical resolution of the patient’s primary hyperparathyroidism. Conclusion This is the first description of a new fellowship paradigm where a senior surgeon provides fellowship training to attending surgeons already in practice.

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Surgeon volume and hospital volume in endocrine neck surgery: how many procedures are needed for reaching a safety level and acceptable costs? A systematic narrative review

Cited by 41 publications

References 36 publications

Predictors of Central Compartment Involvement in Patients with Positive Lateral Cervical Lymph Nodes According to Clinical and/or Ultrasound Evaluation

Predictors of Central Compartment Involvement in Patients with Positive Lateral Cervical Lymph Nodes According to Clinical and/or Ultrasound Evaluation

Volume, outcomes, and quality standards in thyroid surgery: an evidence-based analysis—European Society of Endocrine Surgeons (ESES) positional statement

In‐Practice Endocrine Surgery Fellowship: A Novel Training Model

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