Study supports GIRFT’s recommendation on concentration of surgical expertise for parathyroid operations

GIRFT study into volume outcome associations for parathyroid surgery

New research has been published in support of GIRFT’s recommendation that patients who need surgery to remove their parathyroid gland should be directed to surgeons who perform the operation most often.

Volume-Outcome Associations for Parathyroid Surgery in England, written by a team of GIRFT clinicians and researchers, is published in the journal JAMA Surgery, showing that the more parathyroid operations a surgeon performs, the less likely patients are to need repeat surgery within a year or have an extended hospital stay or post-procedural complications.

This supports a key recommendation in the 2021 GIRFT national report for endocrinology, which called for trusts to work collaboratively in networks or to amalgamate services to concentrate surgical expertise, and for centres carrying out parathyroid surgery to ensure surgeons are operating on at least 20 patients per year or that patients are being referred to surgeons in their network who do so.

The authors looked at data for 17,494 patients who had a parathyroidectomy from April 2014 to March 2019; the average age was 62 and almost 80% were women. They found that patients who went on to need repeat parathyroid surgery within a year or develop other complications were more likely to have been treated by surgeons with lower annual volumes.

Most previous studies into the volume-outcome relationship for parathyroid surgery have been smaller in scale and based on US data. This large-scale English study helps to provide the evidence base for clinicians and health systems to improve patient outcomes going forwards.

The authors for GIRFT are:

  • William K Gray, senior research associate
  • Annakan Navaratnam, clinical fellow
  • Professor John Wass, clinical lead for endocrinology
  • Professor Tim Briggs, GIRFT Chair
  • Mark Lansdown, clinical advisor for endocrinology
  • Jamie Day, retired chief information officer.

Mr Lansdown, a consultant endocrine surgeon at Leeds Teaching Hospitals NHS Trust, said: “In any discussion about the concentration of surgical expertise, there will always be wider considerations around potentially greater travel distances for patients and their families, service disruption and financial costs. However, it would seem that the GIRFT proposed threshold of 20 procedures per surgeon per annum may be a pragmatic and achievable initial target.

“Initiatives such as local preoperative screening and postoperative follow-up where travel for surgery is involved, systems for mentoring less experienced surgeons by senior colleagues until they reach minimum volumes, and dedicated endocrine surgery fellowships, would smooth the transition and may support future increases to the threshold.”

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