Elsevier

Surgery

Volume 144, Issue 6, December 2008, Pages 899-907
Surgery

American Association of Endocrine Surgeon
Avoidable reoperations for thyroid and parathyroid surgery: Effect of hospital volume

https://doi.org/10.1016/j.surg.2008.07.022Get rights and content

Background

Hospital volume for thyroid and parathyroid surgery inversely correlates with perioperative complications. This correlation has not been made regarding the need for reoperation.

Methods

We retrospectively analyzed 395 reoperative thyroid (TR) and parathyroid (PR) surgeries at a tertiary care hospital from 1999 to 2007. Based on current standards of care, reoperations were classified as avoidable or unavoidable. Public discharge data were used to classify hospitals as low-volume centers (LVC; <20 cases/yr) or high-volume centers (HVC; ≥20 cases/yr). The χ2 test was used to determine statistical significance.

Results

Hospital data were available for 335 reoperations (85%). There were 134 avoidable (34%) and 201 unavoidable (66%) procedures. Primary hyperparathyroidism (HPT) and thyroid cancer each accounted for a third of cases. Of PR from LVC, 77% were avoidable compared with 22% from HVC (P < .001). Of TR from LVC, 50% were avoidable versus 14% from HVC (P < .001). Operations for both primary HPT and thyroid cancer led to avoidable reoperations more frequently if performed at a LVC (P < .001).

Conclusion

By objective criteria, many thyroid and parathyroid reoperations are avoidable. Most originate from LVC. In addition to decreasing complication rates, thyroid and parathyroid surgery performed at HVC would decrease the need for patients to undergo reoperations.

Section snippets

Methods

All patients undergoing thyroid and parathyroid surgery between 1999 and 2007 at the Cleveland Clinic by 3 endocrine surgeons were retrospectively reviewed. For each reoperation, the hospital where the initial operation took place was identified.

Preoperative imaging studies, intraoperative findings, and histopathology reports of both the initial and subsequent operations were analyzed to classify each reoperation as avoidable or unavoidable using a set of objective criteria (Table I). This set

Study group

During the study period, 280 patients underwent reoperative thyroid and parathyroid procedures; 227 underwent 1 and 53 patients underwent multiple reoperations, for a total of 395 reoperative procedures. Reoperations originating from our institution were included in the analysis. The hospital where the initial operation occurred was available for 335 (85%) of these cases. The remaining 60 cases were excluded from further analysis.

Referring hospital characteristics

Initial operations occurred at 49 different hospitals. Of these,

Discussion

To our knowledge, this is the first study looking at the incidence of avoidable reoperations in thyroid and parathyroid surgery and how it relates to hospital volume. It is also the first study to propose a set of objective criteria with which to classify thyroid and parathyroid operations as avoidable or unavoidable. Although it may seem as though the indications for parathyroid and thyroid reoperations may be widely variable, the set of 10 criteria for parathyroid cases and 8 for thyroid

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