Examining National Guideline Changes Association With Hemithyroidectomy Rates by Surgeon Volume

Introduction: The 2015 American Thyroid Association (ATA) guidelines established that hemithyroidectomy (HT) is an appropriate treatment for patients with low-risk thyroid cancer. HT rates increased since the ATA guidelines were released; however, the rela-tionship between surgeon volume and the initial extent of surgery has not been established.Methods: A statewide database was used to identify patients with thyroid cancer who un-derwent initial thyroidectomy from 2013 to 2020. High-volume thyroid surgeons were defined as those who performed >25 thyroid procedures per year. A mixed-effect logistic model was used to compare low-and high-volume surgeons' initial extent of surgery pre -2015 and post-2015 ATA guidelines. Descriptive statistics were used to describe other surgical outcomes.Results: The analysis included 3199 patients with thyroid cancer who underwent initial thyroidectomy. Twenty-four surgeons (6%) were considered high-volume; they performed 48% (n = 1349) of the operations. After the 2015 ATA guidelines were released, the rate of HT increased significantly for low-(23% to 28%, P = 0.042) but not high-volume (19% to 23%, P = 0.149) surgeons. Low-volume surgeons had significantly higher rates of readmission (P = 0.008), re-operation (P = 0.030), complications (P < 0.001), and emergency room visits (P = 0.002) throughout the entire study period.Conclusions: The publication of the 2015 ATA guidelines was associated with a significant increase in HT rates, primarily in low-volume thyroid surgeons. While low-volume sur-geons began performing more HTs, they continued to have higher rates of readmission, reoperations, complications, and emergency room visits than high-volume surgeons.& COPY; 2022 Elsevier Inc. All rights reserved.

Automated summary

The 2015 ATA guidelines led to an increase in the rate of hemithyroidectomy (HT) primarily performed by low-volume thyroid surgeons. However, the association between surgeon volume and the initial extent of surgery has not been established.