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World J Surg. 2019 Apr 22. doi: 10.1007/s00268-019-05012-z. [Epub ahead of print]

Association of Surgical Volume and Quality Management in Thyroid Surgery: A Two-Nation Multicenter Study.

Author information

1
Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
2
Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
3
Department of Surgery, Krankenanstalt Rudolfstiftung, Vienna, Austria.
4
Department of Nuclear Medicine, Geneva University and University Hospitals of Geneva, Geneva, Switzerland.
5
Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland. reto.kaderli@insel.ch.

Abstract

BACKGROUND:

High-volume caseload in thyroid surgery is associated with lower postoperative complication rates resulting to better outcomes. The aim of the present study was to investigate the correlation of the departments' annual number of thyroid surgeries on the adherence to consensus guidelines and on the implementation of measures for quality assurance.

METHODS:

In 2016, we sent an anonymous electronic survey with questions related to the perioperative management in thyroid surgery to all directors of departments in operative medicine in Switzerland and Austria. We compared the pre- and postoperative management with the summarized recommendations of the four most frequently used consensus guidelines. Analogously, we analyzed the implementation of six measures for quality assurance related to thyroid surgery for each participating department. Using logistic regression analysis, we evaluated the correlation of number of guidelines respected and number of measures for quality assurance with the departments' annual number of surgeries performed. Furthermore, we evaluated the number of departments providing thyroid cancer surgery and their experience in neck dissection.

RESULTS:

The management corresponded in 64.0% to the summarized recommendations. Adherence to the summarized recommendations and implementation of measures for quality assurance were significantly more likely with increasing numbers of surgeries performed (pā€‰=ā€‰0.049 and pā€‰<ā€‰0.001). Ninety-two departments provided thyroid cancer surgery, whereas 12/92 (13.0%) were not able to perform central and/or lateral neck dissection.

CONCLUSION:

Consensus guidelines are insufficiently implemented within thyroid surgery, and quality management is associated with surgical volume.

PMID:
31011819
DOI:
10.1007/s00268-019-05012-z

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