Surgeon volume and adequacy of thyroidectomy for differentiated thyroid cancer

Introduction. We aimed to determine influence of surgeon volume on (1) frequency of appropriate initial surgery for differentiated thyroid cancer (DTC) and (2) completeness of resection. Methods. We reviewed all initial thyroidectomies (Tx; lobectomy and total) performed in a health system during 2011; surgeons were grouped by number of Tx cases per year. For patients with histologic DTC >= 1 cm, surgeon volume was correlated with initial extent of the operation, and markers of complete resection including uptake on I-123 prescan, thyrotropin stimulated thyroglobulin levels, and I-131 dose administered. Results. Of 1,249 patients who underwent Tx by 42 surgeons, 29% had DTC >= 1 cm without distant metastasis. At a threshold of a >= 30 Tx per year, surgeons were more likely to perform initial total Tx for DTC >= 1 cm (P = .01), and initial resection was more complete as measured by all 3 quantitative markers. For patients with advanced stage disease, a threshold of >= 50 Tx per year was needed before observing improvements in I-123 uptake (P = .004). Conclusion. Surgeons who perform >= 30 Tx a year are more likely to undertake the appropriate initial operation and have more complete initial resection for DTC patients. Surgeon volume is an essential consideration in optimizing outcomes for DTC patients, and even higher thresholds (>= 50 Tx/year) may be necessary for patients with advanced disease.