A. F. Utria1, J. Liao1, M. Belding-Schmitt1, J. Shilyansky2, G. Lal1 1University Of Iowa,General Surgery,Iowa City, IA, USA 2University Of Iowa,Pediatric Surgery,Iowa City, IA, USA
Introduction:
Pediatric thyroid cancer represents approximately 3% of all pediatric malignancies and incidence rates are rising. The first American Thyroid Association guidelines for the management of pediatric thyroid nodules and cancer (2015) recommended that pediatric thyroid surgery be performed by high-volume surgeons (at least 30 cervical endocrine procedures annually). However, other data demonstrate that low-volume surgeons working with multidisciplinary teams also have good outcomes. The aim of this study was to determine the state of current practice and outcomes for pediatric thyroidectomy.
Methods:
The National Surgical Quality Improvement Pediatric database (NSQIP-P) was used to identify all cases of pediatric thyroidectomies and neck dissections at participating hospitals from 2015 and 2016. The CPT codes 60252, 60240, 60220, and 38724 were used to extract cases. Patient, disease and treatment-related factors affecting 30-day outcomes were analyzed using univariate and multivariate analysis. P-values < 0.05 were considered significant.
Results:
There were 771 cases of pediatric thyroidectomy included in our study. The mean age at time of surgery was 13.2 (SD 4.4) years and the majority of patients were female (77%) and Caucasian (73%). Pediatric general surgeons performed the largest proportion of cases (40%), followed by pediatric otolaryngologists (35%), adult general surgeons (19%), and adult otolaryngologists (7%). Malignant diagnoses were present in 30% of cases. The overall rate of complications was 2.9%, with the most frequent 30-day complication being readmission (1.4%). Median length of stay across all specialties was 1 day. On multivariate analysis, adult surgeons were less likely to operate on patients with ASA > 2 (OR: 0.55, 95%CI: 0.37-0.84). In terms of procedures, modified radical neck dissections were more likely to be performed by adult surgeons (OR: 2.46, 95%CI: 1.28-4.72), whereas unilateral thyroidectomies were less likely to be performed by them (OR: 0.64, 95%CI: 0.21-0.98). In addition, adult surgeons were associated with shorter operative times (OR: 0.64, 95%CI: 0.41-0.99). There was no significant difference between pediatric and adult surgeons in terms of patient age, diagnoses, and overall complication rate.
Conclusion:
This multi-institutional study shows that Pediatric surgeons continue to perform the majority of thyroid surgeries in children. Our data, while lacking information on surgeon volume show that thyroid surgery is being safely performed at NSQIP- affiliated hospitals by both adult and pediatric surgeons. Further studies are needed to determine if there are differences in specific procedure related-complications and long-term outcomes between pediatric and adult surgeons.