Abstract
Background
Although the surgeon-volume relationship is well documented for thyroidectomy, less
is known about central neck and lateral neck dissections. The aim of this study was
to evaluate and determine the surgeon-volume threshold for central neck and lateral
neck dissections for thyroid cancer.
Methods
A retrospective analysis of patients with thyroid malignancies who received a central
or lateral neck dissection in the New York Statewide Planning and Research Cooperative
System was performed (2007–2017). Demographic variables included age, sex, race, and
a Charlson Comorbidity Score. Thirty-day complications were identified using International
Classification of Diseases (ICD) codes for central neck, lateral neck, and other surgical
complications. Optimal surgeon-volume threshold was estimated using a change-point
logistic regression. Using the identified threshold, surgeons were then classified
to low versus high volume surgeons. Logistic regression analysis was conducted to
examine the effect of high-volume status on outcomes.
Results
In total, 3,808 patients who underwent neck dissections (3,485 central neck dissections
and 977 lateral neck dissections) were analyzed. Surgeon–volume threshold to distinguish
high volume surgeons for central neck dissections and lateral neck dissections was
7.0 (95% bootstrap confidence interval 1.3–7.5) and 3.3 (1.2–4.8) neck dissections/year,
respectively. For central neck dissection, high volume surgeons were associated with
a lower rate of vocal cord paralysis (odds ratio 0.45 [0.24–0.82]), hypocalcemia (0.31
[0.14–0.65]), and all-cause complications (0.42 [0.29–0.59]). For lateral neck dissection,
high volume surgeons were associated with a lower odds all-cause complications (0.42
[0.23–0.74]) but not lateral neck specific complications (0.18 [0.01–1.07]).
Conclusion
A threshold of 7.0 central neck dissections and 3.3 lateral neck dissections for thyroid
cancer per year improves outcomes. Guidelines for training and centralization of care
can be guided by these results to reduce complications.
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Article info
Publication history
Published online: July 12, 2021
Accepted:
April 11,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
