The volume and outcome relationship for thyroidectomy in England
| Autor: | William K. Gray, Jamie Day, Sebastian Aspinall, Neil Tolley, Mark Lansdown |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Hypoparathyroidism medicine.medical_treatment Stridor 030230 surgery 03 medical and health sciences 0302 clinical medicine Postoperative Complications Tracheostomy Vocal cord palsy medicine Humans business.industry General surgery Confounding Thyroidectomy Volume-outcome relationship Vascular surgery medicine.disease Thyroid surgery Cardiac surgery Hospitalization England Cardiothoracic surgery 030220 oncology & carcinogenesis Surgery Original Article medicine.symptom business Vocal Cord Paralysis Abdominal surgery |
| Zdroj: | Langenbeck's Archives of Surgery |
| ISSN: | 1435-2451 |
| Popis: | Purpose The delivery of surgical care in England has seen a momentum towards centralisation within larger volume hospitals and surgical teams. The aim of this study was to investigate outcomes in England in relationship to hospital and surgeon annual volumes for total thyroidectomy. Methods Data were extracted from the Hospital Episodes Statistics (HES) database for England. A 6-year period (April 2012–March 2018 inclusive) for all adult admissions for thyroidectomy was used in the analysis. The primary outcome measure used was a length of hospital stay greater than 2 days or an emergency readmission within 30 days following surgery. This was used as a proxy for surgical complications. A multilevel modelling strategy was used to adjust for hierarchy and potentially confounding. Results Data for 22,823 total thyroidectomies across 144 hospital trusts were used for analysis. For total thyroidectomy, larger volume surgeons had reduced levels of post-surgical complications; length of stay > 2 and > 4 days; emergency readmission at 30 days; and hypoparathyroidism, vocal cord palsy, stridor, and tracheostomy at 1-year post-surgery. Larger hospital volume was associated with lower levels of emergency readmission at 30 days and hypoparathyroidism at 1 year. Conclusions There is significant correlation between surgeon volume and clinical outcome for total thyroidectomy. The relationship was approximately linear, and a low-volume threshold could not be defined. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-021-02223-8. |
| Databáze: | OpenAIRE |
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