Efecto del cirujano de gran volumen en los resultados de la cirugía de tiroides pediátrica. Una revisión sistemática. | 6430 pacientes | 54.9% de todos los pacientes se sometieron a tiroidectomía total | Revisión sistemática de 10 estudios | Indicaciones quirúrgicas más comunes: | malignidad (41.7%) | hipertiroidismo / tiroiditis (40.5%) | Entre los estudios, las tasas de complicaciones fueron | hipocalcemia transitoria (11.4% - 74.2%) | lesión del nervio recurrente transitoria (0% - 9.7%) | sangrado(0.5% - 4.3%) | Definiciones de un cirujano de gran volumen para tiroidectomías o | ≥9 tiroidectomías pediátricas anuales | >200 tiroidectomías anuales (30 siendo pediátricas) | 4 estudios mostraron significativamente mejores resultados: | menor tasa de complicaciones posoperatorias | menor estadía hospitalaria | en pacientes tratados por cirujanos de gran volumen | Conclusión: Los pacientes pediátricos con patología tiroidea tienen, en general, mejores resultados cuando son operados por cirujanos denominados de gran volumen. | https://doi.org/10.1016/j.jpedsurg.2021.12.005 | Source: Olson SL et.al. | División de Cirugía pediátrica, Universidad Feinberg del Noroeste escuela de medicina, Hospital de niños de Chicago Ann & Robert H. Lurie | @EmTombash | @StayCurrentMD | Cincinnati Children's | Journal of Pediatric Surgery
Efecto del volumen quirúrgico del cirujano en cirugías pediátricas de tiroides: Una revisión sistemática
Infographic · Jan 2023 · 1 min read
In brief
In brief
This systematic review of 6,430 pediatric thyroidectomy cases examines the relationship between surgeon volume and outcomes. Despite varied definitions of high-volume surgeons, four studies found significantly better outcomes including fewer complications and shorter hospital stays when children were treated by higher-volume surgeons.
- Higher-volume surgeons demonstrate significantly lower post-operative complications and shorter hospital stays in pediatric thyroidectomy.
- Transient hypocalcemia rates vary widely (11.4%-74.2%) across studies, highlighting the importance of surgeon experience.
- Concentrating pediatric thyroid cases to fewer, high-volume surgeons within practices may improve patient outcomes.
- No consensus exists on defining 'high-volume' — thresholds range from ≥9 to >200 annual thyroid operations.
- Most pediatric thyroidectomies are total thyroidectomies (54.9%) performed for malignancy (41.7%) or hyperthyroidism (40.5%).
Written by the GCMD Library team from the infographic.
Multi-panel infographic with teal and yellow color scheme. Top section features calendar icon and thyroid gland illustration alongside patient statistics. Middle section lists surgical indications and complication rates with medical team illustration. Bottom section defines high-volume surgeon criteria and presents conclusions in yellow box. Includes Cincinnati Children's and Journal of Pediatric Surgery branding.
Infografía por Em Tombash
"Efecto del volumen quirúrgico del cirujano en cirugías pediátricas de tiroides: Una revisión sistemática" Sydney L. Olson et.al.
Articulo Completo: https://www.jpedsurg.org/article/S0022-3468(21)00834-4/fulltext
Authors: Sydney L. Olson, Martha-Conley E. Ingram, Peter M. Graffy, Peggy M. Murphy, Yao Tian, Jill H. Samis, Jami L. Josefson, Jeffery C. Rastatter, Mehul V. Raval
Abstract
Background
Pediatric thyroidectomy has been identified as a surgical procedure that may benefit from concentrating cases to high-volume surgeons. This systematic review aimed to address the definition of “high-volume surgeon” for pediatric thyroidectomy and to examine the relationship between surgeon volume and outcomes.
Methods
PubMed, Embase, Cochrane Library, Scopus, Web of Science, ClinicalTrials.gov, and OpenGrey databases were searched for through February 2020 for studies which reported on pediatric thyroidectomy and specified surgeon volume and surgical outcomes.
Results
Ten studies, encompassing 6430 patients, were included in the review. Five single-center retrospective studies reported only on high-volume surgeons, one single center retrospective study reported on only low-volume surgeons, and four national database studies (2 cross sectional, 2 retrospective reviews) reported outcomes for both high-volume and low-volume surgeons. Majority of patients underwent total thyroidectomy (54.9%); common indications for surgery were malignancy (41.7%) and hyperthyroidism/thyroiditis (40.5%). Rates of transient hypocalcemia (11.4% - 74.2%), transient recurrent laryngeal nerve injury (0% - 9.7%), and bleeding (0.5% - 4.3%) varied across studies. Definitions for high-volume pediatric thyroid surgeons ranged from ≥9 annual pediatric thyroid operations to >200 annual thyroid operations (with >30 pediatric cases). Four studies reported significantly better outcomes, including lower post-operative complications and shorter length of hospital stay, for patients treated by high-volume surgeons.
Conclusions
Despite significant variation in caseloads to define volume, pediatric thyroid patients have generally better outcomes when operated on by higher volume surgeons. Concentration thyroidectomy cases to a smaller cohort of surgeons within pediatric practices may confer improved outcomes.
Level of evidence
Systematic Reviews and Meta-Analyses; Level IV