Zaid Al-Qurayshi

Association of Surgeon Volume With Outcomes and Cost Savings Following Thyroidectomy: A National Forecast

IMPORTANCE Incidence of thyroidectomies is continuing to increase. Identifying factors associated with favorable outcomes can lead to cost savings. OBJECTIVE To assess the association of surgeon volume with clinical outcomes and costs of thyroidectomy. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis performed in October of 2014 of adult (≥ 18 years) inpatients in US community hospitals using the Nationwide Inpatient Sample for the years 2003 through 2009. EXPOSURES Thyroidectomy. MAIN OUTCOMES AND MEASURES Complications, length of stay, and cost following thyroidectomy in relation to surgeon volume. Surgeon volumes were stratified into low (1-3 thyroidectomies per year), intermediate (4-29 thyroidectomies per year), and high (≥ 30 thyroidectomies per year). RESULTS A total of 77,863 patients were included. Procedures performed by low-volume surgeons were associated with a higher risk of postoperative complications compared with high-volume surgeons (15.8% vs 7.7%; OR, 1.55 [95% CI, 1.19-2.03]; P = .001). Mean (SD) hospital cost was significantly associated with surgeon volume (high volume,

Association of Socioeconomic Status, Race, and Ethnicity With Outcomes of Patients Undergoing Thyroid Surgery

6662.69 [

Assessment of Vocal Fold Function Using Transcutaneous Laryngeal Ultrasonography and Flexible Laryngoscopy.

409.31]; intermediate volume,

Cost-effectiveness of intraoperative nerve monitoring in avoidance of bilateral recurrent laryngeal nerve injury in patients undergoing total thyroidectomy

6912.41 [

Minimal extrathyroidal extension does not affect survival of well-differentiated thyroid cancer

137.20]; low volume,

Association of Malignancy Prevalence With Test Properties and Performance of the Gene Expression Classifier in Indeterminate Thyroid Nodules

10,396.21 [

Immunohistochemistry as an accurate tool for evaluating BRAF-V600E mutation in 130 samples of papillary thyroid cancer

345.17]; P < .001). During the study period, if all operations performed by low-volume surgeons had been selectively referred to intermediate- or high-volume surgeons, savings of 11.2% or 12.2%, respectively, would have been incurred. On the basis of the cost growth rate, greater savings are forecasted for high-volume surgeons. With a conservative assumption of 150,000 thyroidectomies per year in the United States, referral of all patients to intermediate- or high-volume surgeons would produce savings of

A National Perspective of the Risk, Presentation, and Outcomes of Pediatric Thyroid Cancer

2.08 billion or

Analysis of Variations in the Use of Intraoperative Nerve Monitoring in Thyroid Surgery

3.11 billion, respectively, over a span of 14 years. CONCLUSIONS AND RELEVANCE A surgeons expertise (measured by surgical volume of procedures per year) is associated with favorable clinical as well as financial outcomes. Our model estimates that considerable cost savings are attainable if higher-volume surgeons perform thyroid procedures in the United States.

The presentation of lymph nodes in Hashimoto’s thyroiditis on ultrasound

IMPORTANCE For the management of thyroid diseases, there have been few studies aimed at examining the association between disparities and outcomes. OBJECTIVE To measure the effects of race, ethnicity, and socioeconomic status on outcomes following thyroid surgery. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis of 62,722 thyroid procedures identified in the Nationwide Inpatient Sample (NIS) from 2003 through 2009. INTERVENTIONS Thyroidectomy. MAIN OUTCOMES AND MEASURES The first set of outcomes included postoperative complication, length of stay (LOS), and overall cost in relation to selected hospital and surgeon characteristics. The second set encompassed accessibility to different surgeon and hospital volumes, hospital locations, and hospital teaching status based on race/ethnicity, income, and health service payer. RESULTS The majority of cases were total thyroidectomies (57.9%) for benign conditions (60.8%). Low-volume surgeons performed most operations (90.8%). Low surgeon volume was associated with higher risk of postoperative complications compared with higher surgeon volume (17.2% vs 12.1%; P < .001). Low-volume compared with high-volume hospitals had higher rates of postoperative complications (17.7% vs 15.1%; P < .001). High surgeon volume was associated with a decreased LOS (mean [SD], 1.74 [0.02] vs 1.20 [0.07] days; P < .001). In addition, LOS was longer at low-volume hospitals (1.85 [0.02] vs 1.57 [0.03] days; P = .001). Hispanics were more likely to be operated on by low-volume surgeons (odds ratio [OR], 2.04; 95% CI, 1.19-3.48), and in certain regions throughout the United States, blacks were more likely to be operated on by low-volume surgeons. Patients with Medicare (OR, 1.30; 95% CI, 1.13-1.53) and lower income (OR, 1.73; 95% CI, 1.19-2.53) were more likely to be treated at low-volume centers. Minorities, including Hispanics, blacks, and other race/ethnicity, were more likely to have their operation in an urban setting (P < .005 for all). Blacks were less likely to have operations performed at nonteaching institutions (OR, 0.48; 95% CI, 0.38-0.60), as were people without private insurance (P < .05 for Medicare, Medicaid, and self-pay). CONCLUSIONS AND RELEVANCE There are significant socioeconomic and racial disparities in thyroid surgery outcomes. Low-volume centers and surgeons had a significantly longer LOS and higher risk of complications, and inequalities were prevalent concerning access to these high-volume hospitals and surgeons.