Directing patients who need their thyroid gland removed to surgeons who perform the operation most often leads to fewer complications and readmissions, according to a new published paper.
The volume and outcome relationship for thyroidectomy in England, co-authored by members of the Getting It Right First Time (GIRFT) team, is published in Langenbeck’s Archives of Surgery.
The authors analysed data for almost 23,000 total thyroidectomy operations on adults in England in the six years from April 2012 to March 2018. They found an important correlation between the volume of operations a surgeon performs and the number of patients who need to stay longer than two days in hospital or need to return within 30 days due to complications.
The findings support the proposed recommendation in the forthcoming GIRFT national report for endocrinology, which is expected to show how consolidating thyroid surgery (as well as parathyroid, adrenal and pituitary surgery) to high-volume surgeons can improve outcomes for patients and reduce the length of time they need to stay in hospital – especially important in the context of the COVID-19 pandemic.
The study did not define a minimum annual threshold for surgeons, but suggests measures should be taken to minimise low-volume thyroid surgery as a priority. The authors support the recommendations by the British Association of Endocrine and Thyroid Surgeons (BAETS) that surgeons should perform at least 20 thyroidectomy operations every year to maintain expertise.
The paper was written by GIRFT’s senior research associate William Gray, retired chief information officer Jamie Day and clinical ambassador and consultant endocrine surgeon Mark Lansdown, alongside Sebastian Aspinall (audit lead for BAETS), and Neil Tolley (Imperial College Healthcare NHS Trust).
Mr Lansdown said: “The GIRFT programme has long studied the impact on patients and healthcare resources of low-volume surgery, and seeks to provide evidence as to whether patient outcomes are linked to surgical volume to better inform national decision-makers.
“We hope this paper serves to support what we concluded from our deep dive visits to endocrinology teams in trusts across England – that we need to prioritise measures to minimise the amount of low-volume surgery, to benefit both patients and the wider NHS.”