Judge Paul D, Menousek Joseph, Schramm Jordan C, Cusick Robert, Lydiatt William
Otolaryngology/Head and Neck Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA.
University of Nebraska Medical Center School of Medicine, Omaha, Nebraska, USA.
OTO Open. 2017 Aug 24;1(3):2473974X17728257. doi: 10.1177/2473974X17728257. eCollection 2017 Jul-Sep.
To examine outcomes of pediatric thyroidectomy in the context of training background, institution, and experience of the surgeon.
Case series with chart review.
A tertiary academic medical center and a pediatric hospital.
Eighty-one thyroidectomy patients younger than 18 years. Outcomes were major complications (recurrent laryngeal nerve injury, permanent hypocalcemia, and wound infection), length of stay (LOS), and need for repeat surgery.
Eighty-one patients, 39 from the University of Nebraska Medical Center and 42 from the Children's Hospital and Medical Center-Omaha, were identified over a 12-year time period. No difference was found in surgeon training (otolaryngology/head and neck surgery vs general/pediatric surgery) for complications (1 vs 1, odds ratio [OR] = 0.76, 95% confidence interval [CI] = [0.05, 13.1]), LOS >1 day (5 vs 13, OR = 0.39, 95% CI = [0.13, 1.24]), or need for second surgery (4 vs 7, OR = 1.47, 95% CI = [0.39, 5.49]). Higher surgeon volume (≥12 surgeries) was found to be significant for decreased need for second surgery (3 vs 8, OR = 6.67, 95% CI = [1.57, 27.17]). Patients of higher-volume surgeons were 4.2 times more likely to stay in the hospital 1 day or less compared with those patients operated on by surgeons with less experience (7 vs 11, 95% CI = [1.59, 15.0]).
Need for second surgery in pediatric thyroidectomy may be predicted by surgical volume.
在外科医生的培训背景、所在机构及经验的背景下，研究小儿甲状腺切除术的结果。
病例系列并进行图表回顾。
一家三级学术医疗中心和一家儿童医院。
81例18岁以下的甲状腺切除术患者。结果指标为主要并发症（喉返神经损伤、永久性低钙血症和伤口感染）、住院时间（LOS）以及再次手术需求。
在12年的时间里，共确定了81例患者，其中39例来自内布拉斯加大学医学中心，42例来自奥马哈儿童医院及医疗中心。在并发症方面（1例对1例，优势比[OR]=0.76，95%置信区间[CI]=[0.05, 13.1]）、住院时间>1天（5例对13例，OR = 0.39，95% CI = [0.13, 1.24]）或二次手术需求方面（4例对7例，OR = 1.47，95% CI = [0.39, 5.49]），未发现外科医生培训类型（耳鼻喉科/头颈外科与普通/小儿外科）之间存在差异。发现外科医生手术量较高（≥12例手术）对于减少二次手术需求具有显著意义（3例对8例，OR = 6.67，95% CI = [1.57, 27.17]）。与经验较少的外科医生所手术的患者相比，手术量较高的外科医生的患者住院1天或更短时间的可能性高出4.2倍（7例对11例，95% CI = [1.59, 15.0]）。
小儿甲状腺切除术中的二次手术需求可能可通过手术量来预测。
