Mitchell Jamie, Milas Mira, Barbosa German, Sutton Jazmine, Berber Eren, Siperstein Allan
Endocrinology and Metabolism Institute, Section of Endocrine Surgery, The Cleveland Clinic, Cleveland, Ohio, USA.
Surgery. 2008 Dec;144(6):899-906; discussion 906-7. doi: 10.1016/j.surg.2008.07.022.
Hospital volume for thyroid and parathyroid surgery inversely correlates with perioperative complications. This correlation has not been made regarding the need for reoperation.
We retrospectively analyzed 395 reoperative thyroid (TR) and parathyroid (PR) surgeries at a tertiary care hospital from 1999 to 2007. Based on current standards of care, reoperations were classified as avoidable or unavoidable. Public discharge data were used to classify hospitals as low-volume centers (LVC; <20 cases/yr) or high-volume centers (HVC; >/=20 cases/yr). The chi(2) test was used to determine statistical significance.
Hospital data were available for 335 reoperations (85%). There were 134 avoidable (34%) and 201 unavoidable (66%) procedures. Primary hyperparathyroidism (HPT) and thyroid cancer each accounted for a third of cases. Of PR from LVC, 77% were avoidable compared with 22% from HVC (P < .001). Of TR from LVC, 50% were avoidable versus 14% from HVC (P < .001). Operations for both primary HPT and thyroid cancer led to avoidable reoperations more frequently if performed at a LVC (P < .001).
By objective criteria, many thyroid and parathyroid reoperations are avoidable. Most originate from LVC. In addition to decreasing complication rates, thyroid and parathyroid surgery performed at HVC would decrease the need for patients to undergo reoperations.
甲状腺和甲状旁腺手术的医院手术量与围手术期并发症呈负相关。但关于再次手术的必要性，尚未建立这种相关性。
我们回顾性分析了1999年至2007年在一家三级医疗中心进行的395例再次甲状腺（TR）和甲状旁腺（PR）手术。根据当前的护理标准，再次手术被分为可避免或不可避免。利用公开的出院数据将医院分为低手术量中心（LVC；每年<20例）或高手术量中心（HVC；每年≥20例）。采用卡方检验确定统计学意义。
335例再次手术（85%）可获取医院数据。其中有134例（34%）可避免手术和201例（66%）不可避免手术。原发性甲状旁腺功能亢进（HPT）和甲状腺癌各占病例的三分之一。LVC的PR手术中，77%是可避免的，而HVC为22%（P<.001）。LVC的TR手术中，50%是可避免的，而HVC为14%（P<.001）。如果在LVC进行原发性HPT和甲状腺癌的手术，导致可避免再次手术的频率更高（P<.001）。
根据客观标准，许多甲状腺和甲状旁腺再次手术是可避免的。大多数源于LVC。除了降低并发症发生率外，在HVC进行甲状腺和甲状旁腺手术还将减少患者再次手术的需求。
