Hauch Adam, Al-Qurayshi Zaid, Randolph Gregory, Kandil Emad
Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA,
Ann Surg Oncol. 2014 Nov;21(12):3844-52. doi: 10.1245/s10434-014-3846-8. Epub 2014 Jun 19.
There has been an increased use of total thyroidectomy (TT), including in the management of benign thyroid diseases. We sought to compare the risk of complications between TT and unilateral thyroidectomy (UT) and to evaluate the effect of surgeon's experience on outcomes.
Nationwide Inpatient Sample from 2003 to 2009 was used to perform cross-sectional analysis of all adult patients who underwent TT and UT for benign or malignant conditions. Logistic regression was used to evaluate outcomes and to provide correlation between outcome and surgeon volume. Surgeon volume was categorized as low or high (performing <10 or >99 thyroid operations/year, respectively).
A total of 62,722 procedures were included. Most cases were TT (57.9 %) performed for benign disease. There was a significantly increased risk of complication after TT compared to UT (20.4 vs. 10.8 %: p < 0.0001). High-volume surgeons performed only 5.0 % of the procedures overall, with 62.6 % of the high-volume surgeon procedures being TTs. Low-volume surgeons were more likely to have postoperative complications after TT compared to high-volume surgeons (odds ratio 1.53, 95 % confidence interval 1.12, 2.11, p = 0.0083). Mean charges were significantly higher for TT compared to lobectomy ($19,365 vs. $15,602, p < 0.0001), and length of stay was longer for TT compared to lobectomy (1.63 vs. 1.29 days, p < 0.0001).
TT is associated with a significantly higher risk of complications compared to UT even among high-volume surgeons. Higher surgeon volume is associated with improved patient outcomes.
全甲状腺切除术（TT）的使用有所增加，包括用于良性甲状腺疾病的治疗。我们试图比较TT与单侧甲状腺切除术（UT）的并发症风险，并评估外科医生经验对手术结果的影响。
使用2003年至2009年的全国住院患者样本，对所有因良性或恶性疾病接受TT和UT的成年患者进行横断面分析。采用逻辑回归评估手术结果，并提供结果与外科医生手术量之间的相关性。外科医生手术量分为低或高（分别为每年进行<10例或>99例甲状腺手术）。
共纳入62,722例手术。大多数病例为因良性疾病进行的TT（57.9%）。与UT相比，TT后并发症风险显著增加（20.4%对10.8%：p<0.0001）。高手术量的外科医生仅进行了总体手术的5.0%，其中62.6%的高手术量外科医生手术为TT。与高手术量外科医生相比，低手术量外科医生进行TT后更易出现术后并发症（比值比1.53，95%置信区间1.12，2.11，p = 0.0083）。与甲状腺叶切除术相比，TT的平均费用显著更高（19,365美元对15,602美元，p<0.0001），TT的住院时间也比甲状腺叶切除术更长（1.63天对1.29天，p<0.0001）。
即使在高手术量外科医生中，TT与UT相比并发症风险也显著更高。外科医生手术量越高，患者手术结果越好。
