A. D. McDow1, J. D. Mellinger1, S. Ganai1, S. S. Desai2 1Southern Illinois University School Of Medicine,General Surgery,Springfield, IL, USA 2Southern Illinois University School Of Medicine,Vascular Surgery,Springfield, IL, USA
Introduction: General surgeons (GS) and otolaryngologists (ENT) commonly perform thyroid surgery. Each specialty differs in surgical training, including residency structure and breadth of operative experience. The aim of this study is to evaluate the impact of surgeon specialty and volume on outcomes following total thyroidectomy for cancer.
Methods: A retrospective cohort study was performed on patients undergoing total thyroidectomy for thyroid cancer between 2007 and 2011 as identified from the National Inpatient Sample (NIS). Physician identifiers were used to classify surgical specialty based on procedural complement. Propensity score matching for comorbidities was performed to allow for comparisons between GS and ENT for outcomes including complications, mortality, length of stay (LOS), and cost of care. Comparisons between provider volume and complication rates were also assessed.
Results: A total of 11,391 inpatient total thyroidectomies were identified in the NIS, of which 54% were performed by ENT and 46% by GS. Postoperative complications occurred in 3.4% of both groups. GS were less likely than ENT to have neurologic (p<0.01), respiratory (p<0.01), and hemorrhagic complications (p<0.001), and were more likely to have speech disturbances (p<0.05). There was no significant difference in inpatient mortality between providers; however, the cost of care and LOS were significantly lower for GS. After propensity score matching for comorbidities, cost ($8,304 vs. $11,530; p<0.001) and LOS (1.7 days vs. 2.3 days; p<0.001) remained significantly lower for GS in comparison to ENT. Surgeons, regardless of specialty, who performed less than 5 total thyroidectomies per year had a higher complication rate compared to those with higher volume.
Conclusion: While generalizability is limited based on exclusion of outpatient procedures, our analysis shows that physician specialty and case volume are significantly associated with cost, length of stay, and complication rate following total thyroidectomy. A more detailed evaluation of the differences in technique and postoperative management between the two specialties may inform changes in practice that may benefit patients who undergo total thyroidectomy by either specialty.