St.Paul's Hospital & University of British Columbia, Department of Surgery, Vancouver, British Columbia, Canada.
Aberdeen Royal Infirmary, Aberdeen, United Kingdom.
Surg Oncol. 2021 Sep;38:101550. doi: 10.1016/j.suronc.2021.101550. Epub 2021 Apr 6.
The study aim was to systematically review literature evaluating surgeon volume-outcome relationships for thyroid and parathyroid operations in order to inform surgical quality improvement initiatives. Current literature suggests surgeons who perform a high volume of thyroid and/or parathyroid operations have better outcomes than low volume surgeons, though specific volume definition are not standardized.
Eligible studies were selected through a literature search focused on the effect of surgeon volume on thyroid and parathyroid surgery patient outcomes. The literature search was conducted in accordance with the PRISMA guidelines. Publication dates extended from January 1998 to February 2021, and were limited to articles published in English.
A total of 33 studies were included: 25 studies evaluating thyroid surgery outcomes, 4 studies evaluating parathyroid surgery outcomes, and 4 studies evaluating both thyroid and parathyroid (mixed) surgery outcomes. Higher volume thyroid and parathyroid surgeons were found to be associated with fewer surgical and medical complications, shorter length of hospital stay, and reduced total cost when compared to lower volume surgeons. This volume-outcome relationship was also found to specifically affect the complication and recurrence rates for thyroid cancer patients undergoing surgery, especially for individuals with advanced stage disease.
The heterogeneity in cut-offs used for characterizing surgeons as high versus low volume, and also in subsequent patient outcome measures, limited direct study comparisons. The trend of improved patient outcomes with higher surgeon volume for both thyroid and parathyroid surgeries was consistently present in all studies reviewed.
本研究旨在系统地回顾评估甲状腺和甲状旁腺手术医师手术量与预后关系的文献，以为外科质量改进措施提供信息。目前的文献表明，手术量大的甲状腺和/或甲状旁腺手术医师的治疗效果优于手术量小的医师，尽管具体的手术量定义尚未标准化。
通过一项聚焦于外科医师手术量对甲状腺和甲状旁腺手术患者结局影响的文献检索，选择符合条件的研究。文献检索符合 PRISMA 指南的要求。检索时间范围为 1998 年 1 月至 2021 年 2 月，仅限于英文发表的文章。
共纳入 33 项研究：25 项评估甲状腺手术结局的研究，4 项评估甲状旁腺手术结局的研究，以及 4 项同时评估甲状腺和甲状旁腺（混合）手术结局的研究。与低手术量医师相比，高手术量的甲状腺和甲状旁腺手术医师与更少的手术和医疗并发症、更短的住院时间和更低的总费用相关。这种手术量与预后的关系也被发现对接受手术的甲状腺癌患者的并发症和复发率有特定影响，尤其是对晚期疾病患者。
用于定义高、低手术量医师的界值以及后续的患者结局测量指标的异质性限制了直接的研究比较。所有纳入的研究都一致表明，甲状腺和甲状旁腺手术中，手术医师手术量越高，患者结局越好。
