外科医生手术量对小儿甲状腺手术结果的影响：系统评价。
Effect of surgeon volume on pediatric thyroid surgery outcomes: A systematic review.
机构信息
Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.
Pritzker Research Library, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.
出版信息
J Pediatr Surg. 2022 Sep;57(9):208-215. doi: 10.1016/j.jpedsurg.2021.12.005. Epub 2021 Dec 10.
BACKGROUND
Pediatric thyroidectomy has been identified as a surgical procedure that may benefit from concentrating cases to high-volume surgeons. This systematic review aimed to address the definition of "high-volume surgeon" for pediatric thyroidectomy and to examine the relationship between surgeon volume and outcomes.
METHODS
PubMed, Embase, Cochrane Library, Scopus, Web of Science, ClinicalTrials.gov, and OpenGrey databases were searched for through February 2020 for studies which reported on pediatric thyroidectomy and specified surgeon volume and surgical outcomes.
RESULTS
Ten studies, encompassing 6430 patients, were included in the review. Five single-center retrospective studies reported only on high-volume surgeons, one single center retrospective study reported on only low-volume surgeons, and four national database studies (2 cross sectional, 2 retrospective reviews) reported outcomes for both high-volume and low-volume surgeons. Majority of patients underwent total thyroidectomy (54.9%); common indications for surgery were malignancy (41.7%) and hyperthyroidism/thyroiditis (40.5%). Rates of transient hypocalcemia (11.4% - 74.2%), transient recurrent laryngeal nerve injury (0% - 9.7%), and bleeding (0.5% - 4.3%) varied across studies. Definitions for high-volume pediatric thyroid surgeons ranged from ≥9 annual pediatric thyroid operations to >200 annual thyroid operations (with >30 pediatric cases). Four studies reported significantly better outcomes, including lower post-operative complications and shorter length of hospital stay, for patients treated by high-volume surgeons.
CONCLUSIONS
Despite significant variation in caseloads to define volume, pediatric thyroid patients have generally better outcomes when operated on by higher volume surgeons. Concentration thyroidectomy cases to a smaller cohort of surgeons within pediatric practices may confer improved outcomes.
LEVEL OF EVIDENCE
Systematic Reviews and Meta-Analyses; Level IV.
背景
小儿甲状腺切除术已被确定为一种可能受益于集中手术的手术，手术可由高容量外科医生完成。本系统评价旨在确定小儿甲状腺切除术的“高容量外科医生”定义，并研究外科医生手术量与手术结果之间的关系。
方法
通过 2020 年 2 月前的 PubMed、Embase、Cochrane 图书馆、Scopus、Web of Science、ClinicalTrials.gov 和 OpenGrey 数据库搜索报告小儿甲状腺切除术和指定外科医生手术量和手术结果的研究。
结果
纳入了 10 项研究，共纳入 6430 例患者。5 项单中心回顾性研究仅报告了高容量外科医生，1 项单中心回顾性研究仅报告了低容量外科医生，4 项国家数据库研究（2 项横断面研究，2 项回顾性研究）报告了高容量和低容量外科医生的结果。大多数患者接受了全甲状腺切除术（54.9％）；手术的常见指征为恶性肿瘤（41.7％）和甲状腺功能亢进/甲状腺炎（40.5％）。暂时性低钙血症（11.4％-74.2％）、暂时性喉返神经损伤（0％-9.7％）和出血（0.5％-4.3％）的发生率因研究而异。高容量小儿甲状腺外科医生的定义范围从每年≥9 例儿科甲状腺手术到每年>200 例甲状腺手术（>30 例儿科病例）。有 4 项研究报告称，高容量外科医生治疗的患者术后并发症和住院时间更短。
结论
尽管手术量的定义存在很大差异，但儿科甲状腺患者由高容量外科医生手术时总体结果更好。将甲状腺手术集中到儿科实践中的一小部分外科医生中，可能会改善结果。
证据水平
系统评价和荟萃分析；IV 级。
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