For Best Thyroid Surgery Results, Pick Doctor With 25-Plus Cases a Year

With commentary by senior author Julie Ann Sosa, MD, chief of endocrine surgery and leader of the Endocrine Neoplasia Diseases Group, Duke University.

Patients who need to have their thyroid gland removed, due to cancer or other conditions, should seek out a surgeon who performs more than 25 such operations each year, according to new research.

thyroidectomy

That will greatly reduce their risk of complications, according to the study findings. Patients whose surgeons did fewer than 25 thyroid removal surgeries a year were 1.5 times more likely to have complications, the researchers found.

The fewer surgeries, the higher the risks of complications. "If your doctor does, on average, just one total thyroidectomy a year, you have an 87% increase in the odds of sustaining a thyroid complication from your surgery compared to a patient who undergoes a thyroidectomy from a high-volume surgeon who performs 26 or more per year," says Julie Ann Sosa, MD, senior author of the study, chief of endocrine surgery and leader of the neoplasia diseases group at Duke University, Durham, N.C. Complications can include bleeding and damage to the laryngeal nerve that can make it difficult to speak, breathe and swallow.

Finding that ''high-volume'' surgeon may be more difficult than patients think. Dr. Sosa found more than half of the 4,600 surgeons polled only did one thyroidectomy a year.  The majority of patients, she says, are having the surgery done by a ''low-volume'' surgeon. Her study is published online March 8 in the Annals of Surgery.

17,000 Thyroid Gland Removals

The thyroid gland sits at the base of the throat, producing hormones that help regulate metabolism. More than 130,000 thyroidectomies are done each year in the U.S., Dr. Sosa says, and the number is rising. "From 2006 to 2011, the number increased by 30%," she says. Improved diagnostic testing is finding more nodules and cancer, she says, partly helping to explain the increase.

The gland must sometimes be removed due to cancer and to conditions such as enlargement, goiter, overactive thyroid and nodules. 

Dr. Sosa's team evaluated data from nearly 17,000 patients who had a total thyroid removal procedure done between 1998 and 2009, drawing information from a national database.

As the number of surgeries per year increased, complications declined steadily. For instance, those who got surgery from a doctor who did 6 to 10 thyroid removals a year had a 42% higher risk of complications than those whose doctor did more than 25 annually.

Those who had the operation from a doctor who did 16 to 20 procedures a year had a 10% higher risk of complications compared to those who had the surgery from a doctor who did more than 25 a year.

The surgeons involved in the study performed 1-to-157 procedures a year, with a median total (half more, half less) of 7 annually. Overall, 6% of patients had at least one complication after the surgery. 

The news that an experienced surgeon has fewer complications has been reported time and again. Dr. Sosa says she first published on the topic as far back as 1998. What was missing, she says, was an actual number, a volume threshold for total removal of the thyroid.

Patients want to know how many procedures are sufficient to declare a doctor experienced enough, she says.

Second Opinion

Minisha Sood, MD, an endocrinologist and director of inpatient diabetes at Lenox Hill Hospital, New York, reviewed the new research. "I don't know if I agree with that number [26] per se,'' she says. But she does believe that surgeons performing thyroidectomies should have ample experience.

That's especially true if the diagnosis is cancer, she says, so the operation is successful. 

So how does a patient find out for sure how many thyroids their potential doctor has removed? Simply ask, Dr. Sosa says, in a direct way. "How many thyroidectomies do you do per year?"

There may not always be a way to validate the response, Dr. Sosa says. However, she points out, physicians should be expected to give an honest answer.

Patients should also ask their doctor what their personal complication rate is, she says. That does not mean quoting the complication rate from medical research, she says, but rather telling the patient the complication rate from his or her own patients. 

 

 

  

 

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