Jensen Catherine B, Bacon Elizabeth M, Krumeich Lauren N, Underwood Hunter J, Hughes David T, Gauger Paul G, Burney Richard, Pitt Susan C
Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA.
World J Surg. 2024 Dec;48(12):2925-2933. doi: 10.1002/wjs.12367. Epub 2024 Oct 15.
Surgical quality improvement (QI) plays a critical role in optimizing patient outcomes and reducing healthcare costs. QI programs focusing specifically on thyroid cancer surgical care are lacking. This study aimed to (a) select and introduce surgical quality indicators for thyroid cancer and (b) identify areas for QI at the state-level.
A multidisciplinary team of thyroid cancer and QI experts selected 10 thyroid cancer-specific quality indicators and assessed the quality of thyroid cancer surgical care compared to current national guidelines. Analysis of the first year (January-December 2023) of data collection was performed using descriptive statistics.
The thyroid cancer quality indicators included preoperative cytology, postoperative pathology, staging, cancer size, margin status, extrathyroidal extension, lymph nodes, postoperative complications within 30 days, documented follow-up treatment, and documented surveillance plans. 112 surgeons performed 360 thyroidectomies for thyroid cancer at 51 hospitals. Preoperative cytology was not performed in 34.3% (n = 103) of cases with thyroid cancer on final pathology. When the extent of surgery was evaluated by papillary cancer size, 50.0% (n = 38) of patients with <1 cm cancers underwent total thyroidectomy, and 13.8% (n = 4) with >4 cm underwent thyroid lobectomy. Positive margins were found in 16.2% (n = 53). Postoperatively, 19.2% (n = 69) of patients lacked documented follow-up, and 18.6% (n = 67) lacked thyroid cancer surveillance plans.
Establishing a dedicated QI program for thyroid cancer provides a previously unharnessed opportunity to enhance the quality of thyroid cancer surgical care. Statewide surgical quality collaboratives offer a model for establishing thyroid cancer QI initiatives across diverse healthcare settings in other states and countries.
手术质量改进（QI）在优化患者治疗效果和降低医疗成本方面发挥着关键作用。专门针对甲状腺癌手术护理的质量改进项目尚属空白。本研究旨在（a）选择并引入甲状腺癌的手术质量指标，以及（b）确定州一级的质量改进领域。
一个由甲状腺癌和质量改进专家组成的多学科团队选择了10项甲状腺癌特异性质量指标，并与当前国家指南相比，评估甲状腺癌手术护理的质量。使用描述性统计方法对第一年（2023年1月至12月）的数据收集进行分析。
甲状腺癌质量指标包括术前细胞学检查、术后病理学检查、分期、癌灶大小、切缘状态、甲状腺外侵犯、淋巴结情况、30天内术后并发症、记录在案的后续治疗以及记录在案的监测计划。112名外科医生在51家医院为甲状腺癌患者实施了360例甲状腺切除术。最终病理显示，34.3%（n = 103）的甲状腺癌病例未进行术前细胞学检查。当根据乳头状癌大小评估手术范围时，癌灶<1 cm的患者中有50.0%（n = 38）接受了全甲状腺切除术，癌灶>4 cm的患者中有13.8%（n = 4）接受了甲状腺叶切除术。切缘阳性率为16.2%（n = 53）。术后，19.2%（n = 69）的患者缺乏记录在案的后续治疗，18.6%（n = 67）的患者缺乏甲状腺癌监测计划。
为甲状腺癌建立专门的质量改进项目提供了一个前所未有的机会，以提高甲状腺癌手术护理的质量。全州范围内的手术质量合作项目为其他州和国家在不同医疗环境中建立甲状腺癌质量改进计划提供了一个模式。
