Volume-based trends in thyroid surgery.

OBJECTIVE

to characterize contemporary patterns of thyroid surgical care and variables associated with access to high-volume care.

DESIGN

cross-sectional analysis.

SETTING

maryland Health Service Cost Review Commission database.

PATIENTS

adults who underwent surgery for thyroid disease in Maryland between January 1, 1990, and July 1, 2009.

RESULTS

overall, 21 270 thyroid surgical procedures were performed by 1034 surgeons at 51 hospitals. Procedures performed by high-volume surgeons increased from 15.7% in 1990-1999 to 30.9% in 2000-2009 (odds ratio [OR], 3.69; P < .001), while procedures performed at high-volume hospitals increased from 11.9% to 22.7% (3.46; P < .001). High-volume surgeons were more likely to perform total thyroidectomy (OR, 2.50; P < .001) and neck dissection (1.86; P < .001), had a shorter length of hospitalization (0.44; P < .001), and had a lower incidence of recurrent laryngeal nerve injury (0.46; P = .002), hypocalcemia (0.62; P < .001), and thyroid cancer surgery (0.89; P = .01). After controlling for other variables, thyroid surgery in 2000-2009 was associated with high-volume surgeons (OR, 1.76; P < .001), high-volume hospitals (2.93; P < .001), total thyroidectomy (2.67; P < .001), and neck dissection (1.28; P = .02) but was less likely to be performed for cancer (0.83; P < .001).

CONCLUSIONS

the proportion of thyroid surgical procedures performed by high-volume surgeons and in high-volume hospitals increased significantly from 1990-1999 to 2000-2009, with an increase in total thyroidectomy and neck dissection. Surgeon volume was significantly associated with complication rates. Thyroid cancer surgery was less likely to be performed by high-volume surgeons and in 2000-2009 despite an increase in surgical cases. Further investigation is needed to identify factors contributing to this trend.