Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
J Pediatr Surg. 2019 Jun;54(6):1226-1232. doi: 10.1016/j.jpedsurg.2019.02.033. Epub 2019 Mar 1.
Previous studies of pediatric thyroidectomies suggest a volume-outcome relationship, but none have focused exclusively on pediatric surgical specialists. Our objective was to examine the effects of pediatric surgeon volume and specialty on post-thyroidectomy outcomes.
The Pediatric Health Information System was queried for patients ≤21 years who underwent partial or total thyroidectomy between 2005 and 2016. Multivariable logistic regression with propensity score weighting was used to assess the relationships between surgeon volume or specialty and 90-day thyroidectomy-specific complications. High-volume surgeons/hospitals were defined as those in the top tertile of annual thyroidectomies.
The inclusion criteria were met by 3149 patients. Patients treated by higher-volume surgeons had significantly fewer complications than those treated by lower-volume surgeons (15.0% vs. 19.2%, p = 0.01). Patients with thyroid cancer also had less morbidity when treated by higher-volume surgeons compared to lower-volume surgeons (25.0% vs. 35.1%, p = 0.03), as did children with Graves' disease (19.8% vs. 29.3%, p = 0.007). Patients managed by pediatric surgeons had fewer complications than those managed by pediatric otolaryngologists across all patients (14.0% vs. 22.5%, p < 0.001) and among cancer (25.3% vs. 42.1%, p < 0.001) and Graves' patients (20.1% vs. 37.3%, p < 0.001) specifically.
Morbidity following pediatric thyroidectomy is associated with surgeon volume.
Prognostic Study.
Level II.
先前的小儿甲状腺切除术研究表明存在手术量-结局关系，但尚无研究专门针对小儿外科专家。我们的目的是检验小儿外科医生手术量和专业领域对甲状腺切除术后结果的影响。
通过小儿健康信息系统检索 2005 年至 2016 年间行甲状腺部分或全切除术的≤21 岁患者。采用多变量逻辑回归和倾向评分加权法评估外科医生手术量或专业领域与 90 天甲状腺切除术特定并发症之间的关系。高手术量医生/医院定义为每年甲状腺切除术例数排名在前 1/3 的医生/医院。
符合纳入标准的患者共 3149 例。与低手术量医生相比，高手术量医生治疗的患者并发症明显更少（15.0% vs. 19.2%，p=0.01）。与低手术量医生相比，甲状腺癌患者在高手术量医生处治疗时发病率也更低（25.0% vs. 35.1%，p=0.03），Graves 病患儿也更低（19.8% vs. 29.3%，p=0.007）。在所有患者中（14.0% vs. 22.5%，p<0.001）和癌症患者中（25.3% vs. 42.1%，p<0.001）以及 Graves 病患者中（20.1% vs. 37.3%，p<0.001），小儿外科医生管理的患者并发症均少于小儿耳鼻喉科医生管理的患者。
小儿甲状腺切除术后的发病率与外科医生手术量有关。
预后研究。
Ⅱ级。
