Pediatric endocrine surgery: Who is operating on our children?

• Published in: Surgery Vol. 144; no. 6; pp. 869 - 877
• Main Authors: Tuggle, Charles T., BS, Roman, Sanziana A., MD, Wang, Tracy S., MD, MPH, Boudourakis, Leon, BS, Thomas, Daniel C., BS, Udelsman, Robert, MD, MBA, Ann Sosa, Julie, MA, MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-12-2008
• Subjects: Adolescent; Child; Child, Preschool; Cross-Sectional Studies; Female; General Surgery - manpower; Humans; Infant; Infant, Newborn; Length of Stay; Male; Parathyroid Diseases - surgery; Parathyroidectomy - economics; Parathyroidectomy - statistics & numerical data; Surgery; Thyroid Diseases - surgery; Thyroidectomy - economics; Thyroidectomy - statistics & numerical data
• DOI: 10.1016/j.surg.2008.08.033
• EISSN: 1532-7361
• ISSN: 0039-6060

Background High surgeon volume is associated with improved outcomes in adult endocrine surgery. This is the first population-based outcomes study for thyroidectomy/parathyroidectomy in children. Methods Cross-sectional analyses were performed using 1999 to 2005 Healthcare Cost and Utilization Project Nationwide Inpatient Sample data. Outcomes included complications, length of stay (LOS), and costs. High-volume surgeons performed >30 cervical endocrine procedures per year in adults and children; pediatric surgeons restricted >90% of their practices to patients ≤17 years old. Other surgeons fell into neither category. Bivariate and multivariate regression analyses were performed. Results We included 607 patients, representing 20% of the pediatric endocrine operations done between 1999 and 2005 in the United States. Seventy-six percent of patients were female. Among the procedures performed, 92% were thyroidectomies and 8% were parathyroidectomies. Surgeons were classified as follows: 18% High-volume, 21% Pediatric, and 61% Other. High-volume surgeons had the lowest LOS (1.5 days vs 2.3 Pediatric, 2.0 Other; P = .01), costs ($12,474 vs $19,594 Pediatric, $13,614 Other; P < .01), and complications (6% vs 11% Pediatric, 10% Other; P = NS). In multivariate analyses, case volume of the endocrine surgeons was an independent predictor of LOS and costs. Conclusion High-volume surgeons have better outcomes after thyroidectomy/parathyroidectomy in children compared with Pediatric and Other surgeons. Surgeon experience was an independent predictor of LOS and costs. High-volume endocrine and pediatric surgeons could combine expertise to improve outcomes in children.