Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon F-69003, France.
BMJ. 2012 Jan 10;344:d8041. doi: 10.1136/bmj.d8041.
To determine the association between surgeons' experience and postoperative complications in thyroid surgery.
Prospective cross sectional multicentre study.
High volume referral centres in five academic hospitals in France.
All patients who underwent a thyroidectomy undertaken by every surgeon in these hospitals from 1 April 2008 to 31 December 2009.
Presence of two permanent major complications (recurrent laryngeal nerve palsy or hypoparathyroidism), six months after thyroid surgery. We used mixed effects logistic regression to determine the association between length of experience and postoperative complications.
28 surgeons completed 3574 thyroid procedures during a one year period. Overall rates of recurrent laryngeal nerve palsy and hypoparathyroidism were 2.08% (95% confidence interval 1.53% to 2.67%) and 2.69% (2.10% to 3.31%), respectively. In a multivariate analysis, 20 years or more of practice was associated with increased probability of both recurrent laryngeal nerve palsy (odds ratio 3.06 (1.07 to 8.80), P=0.04) and hypoparathyroidism (7.56 (1.79 to 31.99), P=0.01). Surgeons' performance had a concave association with their length of experience (P=0.036) and age (P=0.035); surgeons aged 35 to 50 years had better outcomes than their younger and older colleagues.
Optimum individual performance in thyroid surgery cannot be passively achieved or maintained by accumulating experience. Factors contributing to poor performance in very experienced surgeons should be explored further.
确定外科医生经验与甲状腺手术术后并发症之间的关系。
前瞻性横断面多中心研究。
法国五所学术医院的高容量转诊中心。
2008 年 4 月 1 日至 2009 年 12 月 31 日期间，在这些医院接受每位外科医生施行的甲状腺切除术的所有患者。
甲状腺手术后 6 个月时出现 2 种永久性主要并发症（喉返神经麻痹或甲状旁腺功能减退症）。我们使用混合效应逻辑回归来确定经验长短与术后并发症之间的关联。
28 名外科医生在一年期间完成了 3574 例甲状腺手术。喉返神经麻痹和甲状旁腺功能减退症的总发生率分别为 2.08%（95%置信区间 1.53%至 2.67%）和 2.69%（2.10%至 3.31%）。在多变量分析中，20 年或更长时间的从业经验与喉返神经麻痹（比值比 3.06（1.07 至 8.80），P=0.04）和甲状旁腺功能减退症（7.56（1.79 至 31.99），P=0.01）的发生概率增加相关。外科医生的表现与其从业经验（P=0.036）和年龄（P=0.035）呈凹形关联；35 至 50 岁的外科医生比其年轻和年长的同事的结果更好。
甲状腺手术中，个体的最佳表现不能通过积累经验来被动实现或维持。应进一步探讨导致经验丰富的外科医生表现不佳的因素。
