Examining National Guideline Changes Association With Hemithyroidectomy Rates by Surgeon Volume

• Published in: The Journal of surgical research Vol. 283; pp. 858 - 866
• Main Authors: Ellsworth, Brandon L., Sinco, Brandy, Matusko, Niki, Pitt, Susan C., Hughes, David T., Gauger, Paul G., Englesbe, Michael, Underwood, Hunter J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2023
• Subjects: American thyroid association; Complications; Guidelines; Humans; Reoperation; Retrospective Studies; Surgeons; Thyroid Neoplasms - etiology; Thyroid Neoplasms - surgery; Thyroidectomy; Thyroidectomy - methods; United States - epidemiology; United States; American thyroid association; Complications; Thyroidectomy; Guidelines
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2022.11.037

The 2015 American Thyroid Association (ATA) guidelines established that hemithyroidectomy (HT) is an appropriate treatment for patients with low-risk thyroid cancer. HT rates increased since the ATA guidelines were released; however, the relationship between surgeon volume and the initial extent of surgery has not been established. A statewide database was used to identify patients with thyroid cancer who underwent initial thyroidectomy from 2013 to 2020. High-volume thyroid surgeons were defined as those who performed >25 thyroid procedures per year. A mixed-effect logistic model was used to compare low- and high-volume surgeons’ initial extent of surgery pre-2015 and post-2015 ATA guidelines. Descriptive statistics were used to describe other surgical outcomes. The analysis included 3199 patients with thyroid cancer who underwent initial thyroidectomy. Twenty-four surgeons (6%) were considered high-volume; they performed 48% (n = 1349) of the operations. After the 2015 ATA guidelines were released, the rate of HT increased significantly for low- (23% to 28%, P = 0.042) but not high-volume (19% to 23%, P = 0.149) surgeons. Low-volume surgeons had significantly higher rates of readmission (P = 0.008), re-operation (P = 0.030), complications (P < 0.001), and emergency room visits (P = 0.002) throughout the entire study period. The publication of the 2015 ATA guidelines was associated with a significant increase in HT rates, primarily in low-volume thyroid surgeons. While low-volume surgeons began performing more HTs, they continued to have higher rates of readmission, reoperations, complications, and emergency room visits than high-volume surgeons. •After publication of the 2015 ATA guidelines, HT rates increased for low-volume surgeons.•Higher HT rates did not lead to higher CT rates.•Low-volume surgeons had more surgical complications than high-volume surgeons.