Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Division of Pediatric Endocrinology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
J Pediatr Surg. 2022 Oct;57(10):414-420. doi: 10.1016/j.jpedsurg.2022.01.001. Epub 2022 Jan 15.
The topics of sub-specialization and regionalization of care have garnered increased attention among pediatric surgeons. Thyroid surgeries are one such sub-specialty and are commonly concentrated within practices. A national survey was conducted examining current surgeon practices and beliefs surrounding pediatric thyroid surgery.
Non-resident members of the American Pediatric Surgical Association (APSA) were surveyed in October 2020. Respondents were stratified based on self-reported thyroid surgical experience. Those who performed thyroid surgery were asked about surgical technique and operative practices; those who did not were asked about referral patterns. All respondents were asked about perceptions surrounding the volume-outcome relationship for pediatric thyroid surgery.
Among 1015 APSA members, 405 (40%) responded, with 79% (317/400) practicing at academic hospitals, 58% (232/401) practicing in major metropolitan area, and 41% (161/392) with over 10 years of attending pediatric surgery experience. Most respondents (88%, n = 356) agreed that thyroid surgery volume affects outcome, though wide variation was reported in the annual case threshold for "high volume" surgery. Eighty-four respondents (21%) reported performing ≥ 1 pediatric thyroid surgery in the past year. Of these, 82% routinely use recurrent laryngeal nerve monitoring, 32% routinely send hemithyroidectomy patients home the same day, and there was little consensus surrounding postoperative hypocalcemia management. The majority of respondents endorse performing thyroid procedures with a colleague.
Pediatric thyroid surgery appears to be performed by a subset of active pediatric surgeons, most of whom endorse the use of a dual operating team. More evidence is needed to build consensus around additional perioperative practices.
亚专科和护理区域化的话题在小儿外科医生中受到了越来越多的关注。甲状腺手术就是这样的一个亚专科，并且通常集中在某些实践中。进行了一项全国性调查，调查了当前外科医生在小儿甲状腺手术方面的实践和信念。
2020 年 10 月，对美国小儿外科学会（APSA）的非住院成员进行了调查。根据自我报告的甲状腺手术经验对受访者进行分层。那些进行甲状腺手术的人被问到手术技术和手术操作；那些没有进行甲状腺手术的人被问到转诊模式。所有受访者都被问到他们对小儿甲状腺手术的量效关系的看法。
在 1015 名 APSA 成员中，有 405 名（40%）做出了回应，其中 79%（317/400）在学术医院工作，58%（232/401）在主要大都市地区工作，41%（161/392）有超过 10 年的小儿外科手术经验。大多数受访者（88%，n=356）认为甲状腺手术量会影响结果，但对于“高量”手术的年度病例阈值，报告的差异很大。84 名受访者（21%）报告在过去一年中进行了≥1 例小儿甲状腺手术。其中，82%常规使用喉返神经监测，32%常规在同一天让甲状腺次全切除术患者出院，并且术后低钙血症的管理没有达成共识。大多数受访者赞成与同事一起进行甲状腺手术。
小儿甲状腺手术似乎由一组活跃的小儿外科医生进行，其中大多数人赞成使用双手术团队。需要更多的证据来围绕其他围手术期实践达成共识。
