Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland 21287, USA.
Laryngoscope. 2013 Aug;123(8):2056-63. doi: 10.1002/lary.23923. Epub 2013 Jun 4.
OBJECTIVES/HYPOTHESIS: To characterize contemporary patterns of thyroid surgical care and the effect of volume status on surgical care and short-term outcomes.
Retrospective cross-sectional study.
Discharge data from the Nationwide Inpatient Sample for 871,644 patients who underwent surgery for thyroid disease in 1993 through 2008 were analyzed using cross-tabulations and multivariate regression modeling.
Surgical cases increased from 364,288 in 1993 through 2000 to 507,356 in 2001 through 2008, with an increase in thyroid cancer surgical cases from 28% to 34%. Cases performed by high-volume surgeons increased from 12% in 1993 through 2000 to 25% in 2001 through 2008, whereas cases performed by very-low volume surgeons decreased from 51% to 34% (P < .001). Cases performed at high-volume hospitals increased from 14% in 1993 through 2000 to 29% in 2001 through 2008, whereas cases performed at very-low volume hospitals decreased from 46% to 33% (P < .001). High-volume surgeons were significantly more likely to perform total thyroidectomy (odds ratio [OR] = 1.4, P < .001) and had a lower incidence of recurrent laryngeal nerve injury (OR = 0.7, P = .024), hypocalcemia (OR = 0.7, P = .002), and in-hospital death (OR = 0.3, P = .004). High-volume hospital care was not associated with extent of surgery, postoperative morbidity, or mortality after adjusting for surgeon volume. After controlling for other variables, thyroid surgery in 2001 through 2008 was associated with an increase in cases performed by low-volume (relative risk ratio [RRR] = 1.5, P < .001), intermediate-volume (RRR = 1.7, P < .001), and high-volume surgeons (RRR = 2.1, P < .001), high-volume hospitals (RRR = 2.0, P = .008), total thyroidectomy (RRR = 2.1, P < .001), and neck dissection (RRR = 1.3, P = .016).
These data reflect changing trends in the surgical management of thyroid disease, with meaningful differences in the type of surgical care provided by high-volume surgeons.
目的/假设：描述当代甲状腺手术护理模式，并研究手术量对护理和短期预后的影响。
回顾性的横截面研究。
利用交叉表格和多变量回归模型分析了 1993 年至 2008 年期间在全美住院患者样本中接受甲状腺疾病手术的 871644 名患者的出院数据。
手术病例从 1993 年至 2000 年的 364288 例增加到 2001 年至 2008 年的 507356 例，甲状腺癌手术病例从 28%增加到 34%。高容量外科医生进行的手术从 1993 年至 2000 年的 12%增加到 2001 年至 2008 年的 25%，而低容量外科医生进行的手术从 51%减少到 34%（P<0.001）。高容量医院进行的手术从 1993 年至 2000 年的 14%增加到 2001 年至 2008 年的 29%，而低容量医院进行的手术从 46%减少到 33%（P<0.001）。高容量外科医生更有可能进行全甲状腺切除术（比值比[OR] = 1.4，P<0.001），并且喉返神经损伤（OR = 0.7，P = 0.024）、低钙血症（OR = 0.7，P = 0.002）和院内死亡（OR = 0.3，P = 0.004）的发生率较低。在调整外科医生的数量后，高容量医院的护理与手术范围、术后发病率或死亡率无关。在控制其他变量后，2001 年至 2008 年甲状腺手术与低容量（相对风险比[RRR] = 1.5，P<0.001）、中容量（RRR = 1.7，P<0.001）和高容量外科医生（RRR = 2.1，P<0.001）、高容量医院（RRR = 2.0，P = 0.008）、全甲状腺切除术（RRR = 2.1，P<0.001）和颈部淋巴结清扫术（RRR = 1.3，P = 0.016）的手术量增加有关。
这些数据反映了甲状腺疾病手术管理方式的变化趋势，高容量外科医生提供的手术护理类型存在显著差异。
