High-Volume Surgeons Improve Parathyroidectomy Outcomes

The researchers found that patients of high-volume surgeons had a lower rate of vocal cord paralysis compared to patients of low-volume surgeons.
The researchers found that patients of high-volume surgeons had a lower rate of vocal cord paralysis compared to patients of low-volume surgeons.

(HealthDay News) — Patients undergoing parathyroidectomy by high-volume surgeons have a lower rate of vocal cord paralysis compared to patients of low-volume surgeons, according to a study published online in JAMA Otolaryngology-Head & Neck Surgery.

Charles Meltzer, MD, from The Permanente Medical Group in Santa Rosa, Calif., and colleagues examined the correlation between surgeon volume and 30-day rates of complications, mortality, and post-discharge utilization among 2080 adult patients undergoing parathyroidectomy. Low- and high-volume surgeons who performed 20 or fewer vs more than 40 cases per year were compared. Patients receiving parathyroid procedures from low- and high-volume surgeons were matched using propensity scores with 547 matched pairs.

The researchers found that patients of high-volume surgeons had a lower rate of vocal cord paralysis compared to patients of low-volume surgeons (absolute difference, −1.4%). To avoid one case of vocal cord paralysis, the number needed to treat was 71; the number could be as low as 34 based on the upper bound of the confidence interval. More outpatient procedures were performed by high-volume surgeons, with an absolute difference of 25.5%. Other differences did not reach statistical significance.

"Our findings led us to undertake a quality improvement initiative in which patients requiring parathyroid surgery are treated by higher-volume surgeons under care pathways we designed to standardize the treatment of patients with primary hyperparathyroidism," the authors write.

Reference

  1. Meltzer C, Klau M, Gurushanthaiah D, et al. Surgeon Volume in Parathyroid Surgery—Surgical Efficiency, Outcomes, and Utilization. JAMA Otolaryngol Head Neck Surg. 20 April 2017. doi: 10.1001/jamaoto.2017.0124
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