J. Madrigal1, Z. Tran1, J. Hadaya1, K. Darbinian1, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles, Department Of Surgery, Los Angeles, CA, USA
Introduction:
Thyroidectomy is commonly performed by both general surgeons (GS) and otolaryngologists (ENT). Although the importance of surgeon experience on outcomes following thyroidectomy has been well-established, studies on the influence of surgical specialty remain limited. The present study assessed the association of surgical specialty with both practice patterns and postoperative outcomes following total thyroidectomy.
Methods:
All adults undergoing elective total thyroidectomy for neoplasm were identified from the 2016-19 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Surgical specialty as well as other patient and operative characteristics were tabulated utilizing ACS-NSQIP’s data dictionary. Outcomes of interest included rates of clinically severe hypocalcemia, laryngeal nerve injury and neck hematoma as well as operative time and length of stay. Multivariable regression models accounting for patient and operative variables were developed to assess the independent association between surgical specialty and these outcomes.
Results:
Of 9,079 patients undergoing total thyroidectomy, 55.9% were treated by general surgeons and 44.1% by otolaryngologists. Compared to their counterparts, ENT patients were more likely to have tumor staging of at least 3A (25.0 vs 21.4%, P<0.001) as well as nodal (27.6 vs 24.6%, P=0.001) and distant (1.2 vs 0.7%, P=0.008) metastasis. Although both specialties had similar utilization of laryngeal nerve monitoring (63.7 vs 65.4%, P=NS), ENT less frequently used Harmonic Scalpel or LigaSure (45.1 vs 79.5%, P<0.001) but more often placed drains intraoperatively (49.3 vs 16.5%, P<0.001). After multivariable adjustment, patients treated by ENT were at increased risk for clinically severe hypocalcemia though had decreased odds of laryngeal nerve injury (Figure). There were no differences in rate of neck hematoma. Notably, intraoperative nerve monitoring was not protective against laryngeal nerve injury (Adjusted Odds Ratio [AOR] 0.9, 95% Confidence Interval [CI] 0.8-1.1, P=NS). Furthermore, utilization of Harmonic Scalpel or LigaSure (AOR 0.9, 95% CI 0.6-1.4, P=NS) as well as drain placement (AOR 1.1, 95% CI 0.7-1.8, P=NS) had no impact on rate of neck hematoma. Although ENT patients had shorter operative time, they incurred longer lengths of stay (Figure).
Conclusion:
Although most thyroidectomies are performed by general surgeons, otolaryngologists often encounter patients with advanced disease. While both perform this operation with acceptable outcomes, surgical specialty impacts rates of complications. Identification and standardization of practice patterns that mitigate these complications may prove beneficial in both specialties.
