Surgeon perceptions of volume threshold and essential practices for pediatric thyroidectomy
Introduction: The topics of sub-specialization and regionalization of care have garnered increased attention among pediatric surgeons. Thyroid surgeries are one such sub-specialty and are commonly concentrated within practices. A national survey was conducted examining current surgeon practices and beliefs surrounding pediatric thyroid surgery.
Methods: Non-resident members of the American Pediatric Surgical Association (APSA) were surveyed in October 2020. Respondents were stratified based on self-reported thyroid surgical experience. Those who performed thyroid surgery were asked about surgical technique and operative practices; those who did not were asked about referral patterns. All respondents were asked about perceptions surrounding the volume-outcome relationship for pediatric thyroid surgery.
Results: Among 1015 APSA members, 405 (40%) responded, with 79% (317/400) practicing at academic hospitals, 58% (232/401) practicing in major metropolitan area, and 41% (161/392) with over 10 years of attending pediatric surgery experience. Most respondents (88%, n = 356) agreed that thyroid surgery volume affects outcome, though wide variation was reported in the annual case threshold for "high volume" surgery. Eighty-four respondents (21%) reported performing ≥ 1 pediatric thyroid surgery in the past year. Of these, 82% routinely use recurrent laryngeal nerve monitoring, 32% routinely send hemithyroidectomy patients home the same day, and there was little consensus surrounding postoperative hypocalcemia management. The majority of respondents endorse performing thyroid procedures with a colleague.
Conclusions: Pediatric thyroid surgery appears to be performed by a subset of active pediatric surgeons, most of whom endorse the use of a dual operating team. More evidence is needed to build consensus around additional perioperative practices.
Keywords: Pediatric thyroid surgery; Surgeon survey; Surgical outcomes; Surgical specialization; Thyroidectomy; Volume outcome relationship.
Olson SL, Ingram ME, Samis J, Josefson JL, Rastatter JC, Rothstein DH, Danko ME, Moriarty KP, Rich BS, Raval MV; American Academy of Pediatrics Section on Surgery Delivery of Surgical Care Committee. Surgeon perceptions of volume threshold and essential practices for pediatric thyroidectomy✰. J Pediatr Surg. 2022 Jan 15:S0022-3468(22)00037-9. doi: 10.1016/j.jpedsurg.2022.01.001. Epub ahead of print.