Skip to main content
SpringerLink
Log in

Who Should Do Thyroid Surgery?

  • Chapter
Controversies in Thyroid Surgery

  • 1149 Accesses

Abstract

Thyroidectomy is typically associated with low rates of morbidity and mortality, although thyroidectomy-specific complications of recurrent laryngeal nerve injury and hypoparathyroidism have significant consequences for patient quality of life, underscoring the importance of optimizing circumstances for successful patient outcomes. Numerous population-based studies have demonstrated the association between increased surgeon volume and enhanced patient outcomes among patients undergoing thyroidectomy. On average, high-volume surgeons consistently have been shown to have lower (general and endocrine-specific) complication rates, shorter hospital length of stay, and decreased costs; this association is particularly evident for vulnerable populations, such as children, elderly, and racial minorities. The number of procedures considered to be “high-volume” for thyroid surgery is unclear, as the volume thresholds utilized in published studies have been variable, ranging from >30 to >100 procedures per year. Despite increasing referrals to high-volume surgeons, the majority of thyroidectomies are still performed by lower-volume surgeons, in part secondary to geographic and socioeconomic barriers in patient access to high-volume, experienced thyroid surgeons. The challenge will be for educators to think together with policy makers and payers to assure that there is adequate and distributed supply to meet that demand. Going forward, practice guidelines well might include data related to provider volume when formulating best practice recommendations in the arena of thyroid disease.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Sakorafas GH. Historical evolution of thyroid surgery: from the ancient times to the dawn of the 21st century. World J Surg. 2010;34:1793–804.

    Article  PubMed  Google Scholar 

  2. Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998;280:1747–51.

    Article  CAS  PubMed  Google Scholar 

  3. Birkmeyer JD, Siewers AE, Finalyson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37.

    Article  PubMed  Google Scholar 

  4. Gould JC, Kent KC, Wan Y, Rajamanickam V, Leverson G, Campos GM. Perioperative safety and volume: outcomes relationships in bariatric surgery: a study of 32,000 patients. J Am Coll Surg. 2011;213:771–7.

    Article  PubMed  Google Scholar 

  5. Mitchell J, Milas M, Barbosa G, Sutton J, Berber E, Siperstein A. Avoidable reoperations for thyroid and parathyroid surgery: effect of hospital volume. Surgery. 2008;144:899–907.

    Article  PubMed  Google Scholar 

  6. Abdulla AG, Ituarte PH, Harari A, Wu JX, Yeh MW. Trends in the frequency and quality of parathyroid surgery: analysis of 17,082 cases over 10 years. Ann Surg. 2015;261(4):746–50.

    Article  PubMed  Google Scholar 

  7. Birkmeyer JD, Stukel TA, Siewers AE, Gooney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349:2117–27.

    Article  CAS  PubMed  Google Scholar 

  8. Chowdhury MM, Dagash H, Pierro A. A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg. 2007;94:145–61.

    Article  CAS  PubMed  Google Scholar 

  9. Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg. 1998;228:320–30.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Stavrakis AI, Ituarte PH, Ko CY, Yeh MW. Surgeon volume as a predictor of outcomes in inpatient and outpatient endocrine surgery. Surgery. 2007;142:887–99.

    Article  PubMed  Google Scholar 

  11. Boudourakis LD, Wang TS, Roman SA, Desai R, Sosa JA. Evolution of the surgeon-volume, patient-outcome relationship. Ann Surg. 2009;250:159–65.

    Article  PubMed  Google Scholar 

  12. Kandil E, Noureldine SI, Abbas A, Tufano RP. The impact of surgical volume on patient outcomes following thyroid surgery. Surgery. 2013;154:1346–53.

    Article  PubMed  Google Scholar 

  13. Loyo M, Tufano RP, Gourin CG. National trends in thyroid surgery and the effect of volume on short-term outcomes. Laryngoscope. 2013;123:2056–63.

    Article  PubMed  Google Scholar 

  14. Doubani CA, Field TS, Buist DS, Korner EJ, Bigelow C, Lamerato L, Herrinton L, Quinn VP, Hart G, Hornbrook MC, Gurwitz JH, Wagner EH. Racial differences in tumor stage and survival for colorectal cancer in an insured population. Cancer. 2007;109(3):612–20.

    Article  Google Scholar 

  15. Miller JW, Plescia M, Ekwueme DU. Public health national approach to reducing breast and cervical cancer disparities. Cancer. 2014;120 Suppl 16:2537–9.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Sosa JA, Mehta PJ, Wang TS, Yeo H, Roman SA. Racial disparities in clinical and economic outcomes from thyroidectomy. Ann Surg. 2007;246:1083–91.

    Article  PubMed  Google Scholar 

  17. Noureldine SI, Abbas A, Tufano RP, et al. The impact of surgical volume on racial disparity in thyroid and parathyroid surgery. Ann Surg Oncol. 2014;21:2733–9.

    Article  PubMed  Google Scholar 

  18. Papaleontiou M, Haymart MR. New insights in risk stratification of differentiated thyroid cancer. Curr Opin Oncol. 2014;26:1–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Momesso DP, Tuttle RM. Update on differentiated thyroid cancer staging. Endocrinol Metab Clin North Am. 2014;43:401–21.

    Article  PubMed  Google Scholar 

  20. Paasler C, Avanessian R, Kaczirek K, Prager G, Scheuba C, Niederle B. Thyroid surgery in the geriatric patient. Arch Surg. 2002;137:1243–8.

    Article  Google Scholar 

  21. Seybt MW, Khichi S, Terris DJ. Geriatric thyroidectomy: safety of thyroid surgery in an aging population. Arch Otolaryngol Head Neck Surg. 2009;135:1041–4.

    Article  PubMed  Google Scholar 

  22. Mekel M, Stephen AE, Gaz RD, Perry ZH, Hodin RA, Parangi S. Thyroid surgery in octogenarians is associated with higher complication rates. Surgery. 2009;146:913–21.

    Article  PubMed  Google Scholar 

  23. Grogan RH, Mitmaker EJ, Hwang J, Gosnell JE, Duh QY, Clark OH, Shen WT. A population-based cohort study of complications after thyroidectomy in the elderly. J Clin Endocrinol Metab. 2012;97:1645–53.

    Article  CAS  PubMed  Google Scholar 

  24. Tuggle CT, Park LS, Roman S, Udelsman R, Sosa JA. Rehospitalization among elderly patients with thyroid cancer after thyroidectomy are prevalent and costly. Ann Surg Oncol. 2010;11:2816–23.

    Article  Google Scholar 

  25. Sosa JA, Mehta PJ, Wang TS, Boudourakis L, Roman SA. A population-based study of outcomes from thyroidectomy in aging Americans: at what cost? J Am Coll Surg. 2008;206:1097–105.

    Article  PubMed  Google Scholar 

  26. Lieu TA, Newacheck P, McManus M. Race, ethnicity, and access to care among US adolescents. Am J Public Health. 1993;90:1771–4.

    Google Scholar 

  27. Wang TS, Roman SA, Sosa JA. Predictors of outcomes following pediatric thyroid and parathyroid surgery. Curr Opin Oncol. 2008;21:23–8.

    Article  CAS  Google Scholar 

  28. Dinauer CA, Breuer C, Rivkees SA. Differentiated thyroid cancer in children: diagnosis and management. Curr Opin Oncol. 2008;20:59–65.

    Article  PubMed  Google Scholar 

  29. Francis GL, Waguespack SG, Bauer AJ, et al. Management guidelines for children with thyroid nodules and differentiated thyroid cancer, from the American Thyroid Association Guidelines Task Force on Pediatric Thyroid Cancer. Thyroid. 2015;25(7):716–59.

    Google Scholar 

  30. Lee JA, Grumback MM, Clark OH. The optimal treatment for pediatric Graves’ disease is surgery. J Clin Endocrinol Metab. 2007;92:801–3.

    Article  CAS  PubMed  Google Scholar 

  31. Sosa JA, Tuggle CT, Wang TS, Thomas DC, Boudourakis L, Rivkees S, Roman SA. Clinical and economic outcomes of thyroid and parathyroid surgery in children. J Clin Endocrinol Metab. 2008;93:3058–65.

    Article  CAS  PubMed  Google Scholar 

  32. Tuggle CT, Roman SA, Wang TS, Boudourakis L, Thomas DC, Udelsman R, Sosa JA. Pediatric endocrine surgery: who is operating on our children? Surgery. 2008;144:869–77.

    Article  PubMed  Google Scholar 

  33. Wood JH, Partrick DA, Barham HP, Bensard DD, Travers SH, Bruny JL, McIntyre RC. Pediatric thyroidectomy; a collaborative surgical approach. J Pediatr Surg. 2011;46:823–8.

    Article  PubMed  Google Scholar 

  34. Sosa JA, Wang TS, Yeo HL, Mehta PJ, Boudourakis L, Udelsman R, Roman SA. The maturation of a specialty: Workforce projections for endocrine surgery. Surgery. 2007;142:876–83.

    Article  PubMed  Google Scholar 

  35. Zarebczan B, McDonald R, Rajamanickam V, Leverson G, Chen H, Sippel RS. Training our future endocrine surgeons: a look at the endocrine surgery operative experience of U.S. surgical residents. Surgery. 2010;148:1075–81.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Bilimoria KY, Phillips JD, Rock CE, Hayman A, Prystowsky JB, Bentrem DJ. Effect of surgeon training, specialization, and experience on outcomes for cancer surgery: a systematic review of the literature. Ann Surg Oncol. 2009;16:1799–808.

    Article  PubMed  Google Scholar 

  37. Kebebew E, Duh QY, Clark OH. Total thyroidectomy or thyroid lobectomy in patients with low-risk differentiated thyroid cancer: surgical decision analysis of a controversy using a mathematical model. World J Surg. 2000;24:1295–302.

    Article  CAS  PubMed  Google Scholar 

  38. Sosa JA, Udelsman RU. Total thyroidectomy for differentiated thyroid cancer. J Surg Oncol. 2006;94:701–7.

    Article  PubMed  Google Scholar 

  39. Nixon IJ, Ganly I, Patel SG, Palmer FL, Whitcher MM, Tuttle RM, Shaha A, Shah JP. Thyroid lobectomy for treatment of well differentiated thyroid malignancy. Surgery. 2012;151:571–9.

    Article  PubMed  Google Scholar 

  40. Hauch A, Al-Qurayshi Z, Randolph G, Kandil E. Total thyroidectomy is associated with increased risk of complications for low- and high-volume surgeons. Ann Surg Oncol. 2014;21(12):3844–52.

    Article  PubMed  Google Scholar 

  41. Sosa JA, Hanna JW, Robinson KA, Lanman RB. Increases in thyroid nodule fine-needle aspirations, operations, and diagnoses of thyroid cancer in the United States. Surgery. 2013;154(6):1420–6.

    Article  PubMed  Google Scholar 

  42. Bahl M, Sosa JA, Eastwood JD, Hobbs HA, Nelson RC, Hoang JK. Using the 3-tiered system for categorizing workup of incidental thyroid nodules detected on CT, MRI, or PET/CT: how many cancers would be missed? Thyroid. 2014;24(12):1772–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA

    Tracy S. Wang M.D., M.P.H., F.A.C.S.

  2. Endocrine Neoplasia Diseases Group, Duke Cancer Institute, Duke University, DUMC #2945, Durham, NC, 27710, USA

    Julie Ann Sosa M.D., M.A., F.A.C.S.

  3. Department of Surgery, Duke University, DUMC #2945, Durham, NC, 27710, USA

    Julie Ann Sosa M.D., M.A., F.A.C.S.

Authors
  1. Tracy S. Wang M.D., M.P.H., F.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julie Ann Sosa M.D., M.A., F.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tracy S. Wang M.D., M.P.H., F.A.C.S. .

Editor information

Editors and Affiliations

  1. Department of Surgery; University of Virginia Health System, C Bruce Morton Professor and Chief; Division of General Surgery, Charlottesville, Virginia, USA

    John B. Hanks

  2. Chairman Department of Surgery, Mount Sinai Beth Israel, Eugene W Friedman Professor of Surgery; Icahn School of Medicine at Mount Sinai, New York, New York, USA

    William B. Inabnet III

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Wang, T.S., Sosa, J.A. (2016). Who Should Do Thyroid Surgery?. In: Hanks, J., Inabnet III, W. (eds) Controversies in Thyroid Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-20523-6_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-20523-6_5

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-20522-9

  • Online ISBN: 978-3-319-20523-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation