Faculty Collaboration Database

Pediatric endocrine surgery: who is operating on our children? Surgery 2008 Dec;144(6):869-77; discussion 877

Date

12/02/2008

Pubmed ID

19040991

DOI

10.1016/j.surg.2008.08.033

Scopus ID

2-s2.0-56449083473 (requires institutional sign-in at Scopus site)   152 Citations

Abstract

BACKGROUND: High surgeon volume is associated with improved outcomes in adult endocrine surgery. This is the first population-based outcomes study for thyroidectomy/parathyroidectomy in children.

METHODS: Cross-sectional analyses were performed using 1999 to 2005 Healthcare Cost and Utilization Project Nationwide Inpatient Sample data. Outcomes included complications, length of stay (LOS), and costs. High-volume surgeons performed >30 cervical endocrine procedures per year in adults and children; pediatric surgeons restricted >90% of their practices to patients </=17 years old. Other surgeons fell into neither category. Bivariate and multivariate regression analyses were performed.

RESULTS: We included 607 patients, representing 20% of the pediatric endocrine operations done between 1999 and 2005 in the United States. Seventy-six percent of patients were female. Among the procedures performed, 92% were thyroidectomies and 8% were parathyroidectomies. Surgeons were classified as follows: 18% High-volume, 21% Pediatric, and 61% Other. High-volume surgeons had the lowest LOS (1.5 days vs 2.3 Pediatric, 2.0 Other; P = .01), costs ($12,474 vs $19,594 Pediatric, $13,614 Other; P < .01), and complications (6% vs 11% Pediatric, 10% Other; P = NS). In multivariate analyses, case volume of the endocrine surgeons was an independent predictor of LOS and costs.

CONCLUSION: High-volume surgeons have better outcomes after thyroidectomy/parathyroidectomy in children compared with Pediatric and Other surgeons. Surgeon experience was an independent predictor of LOS and costs. High-volume endocrine and pediatric surgeons could combine expertise to improve outcomes in children.

Author List

Tuggle CT, Roman SA, Wang TS, Boudourakis L, Thomas DC, Udelsman R, Ann Sosa J

Author

Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Cross-Sectional Studies
Female
General Surgery
Humans
Infant
Infant, Newborn
Length of Stay
Male
Parathyroid Diseases
Parathyroidectomy
Thyroid Diseases
Thyroidectomy