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Original Investigation |

Association of Surgeon Volume With Outcomes and Cost Savings Following Thyroidectomy A National Forecast

Zaid Al-Qurayshi, MD, MPH1; Russell Robins, PhD2; Adam Hauch, MD, MBA1; Gregory W. Randolph, MD3; Emad Kandil, MD1
[+] Author Affiliations
1Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
2A. B. Freeman School of Business, Tulane University, New Orleans, Louisiana
3Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
JAMA Otolaryngol Head Neck Surg. 2016;142(1):32-39. doi:10.1001/jamaoto.2015.2503.
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Importance  Incidence of thyroidectomies is continuing to increase. Identifying factors associated with favorable outcomes can lead to cost savings.

Objective  To assess the association of surgeon volume with clinical outcomes and costs of thyroidectomy.

Design, Setting, and Participants  Cross-sectional analysis performed in October of 2014 of adult (≥18 years) inpatients in US community hospitals using the Nationwide Inpatient Sample for the years 2003 through 2009.

Exposures  Thyroidectomy.

Main Outcomes and Measures  Complications, length of stay, and cost following thyroidectomy in relation to surgeon volume. Surgeon volumes were stratified into low (1-3 thyroidectomies per year), intermediate (4-29 thyroidectomies per year), and high (≥30 thyroidectomies per year).

Results  A total of 77 863 patients were included. Procedures performed by low-volume surgeons were associated with a higher risk of postoperative complications compared with high-volume surgeons (15.8% vs 7.7%; OR, 1.55 [95% CI, 1.19-2.03]; P = .001). Mean (SD) hospital cost was significantly associated with surgeon volume (high volume, $6662.69 [$409.31]; intermediate volume, $6912.41 [$137.20]; low volume, $10 396.21 [$345.17]; P < .001). During the study period, if all operations performed by low-volume surgeons had been selectively referred to intermediate- or high-volume surgeons, savings of 11.2% or 12.2%, respectively, would have been incurred. On the basis of the cost growth rate, greater savings are forecasted for high-volume surgeons. With a conservative assumption of 150 000 thyroidectomies per year in the United States, referral of all patients to intermediate- or high-volume surgeons would produce savings of $2.08 billion or $3.11 billion, respectively, over a span of 14 years.

Conclusions and Relevance  A surgeon’s expertise (measured by surgical volume of procedures per year) is associated with favorable clinical as well as financial outcomes. Our model estimates that considerable cost savings are attainable if higher-volume surgeons perform thyroid procedures in the United States.

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Figure.
Rate of Cost Increase by Surgeon Volume

Figure shows low (1-3 procedures per year), intermediate (4-29 procedures per year), and high surgeon volume (≥30 procedures per year).

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