Association of Surgeon Volume With Outcomes and Cost Savings Following Thyroidectomy: A National Forecast

Zaid Al-Qurayshi; Russell Robins; Adam Hauch; Gregory W Randolph; Emad Kandil

doi:10.1001/jamaoto.2015.2503

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Association of Surgeon Volume With Outcomes and Cost Savings Following Thyroidectomy: A National Forecast

Journal article

Open access

Peer reviewed

Association of Surgeon Volume With Outcomes and Cost Savings Following Thyroidectomy: A National Forecast

Zaid Al-Qurayshi, Russell Robins, Adam Hauch, Gregory W Randolph and Emad Kandil

JAMA otolaryngology-- head & neck surgery, Vol.142(1), pp.32-8

01/01/2016

DOI: 10.1001/jamaoto.2015.2503

PMID: 26561736

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Published (Version of record) Open Access

Abstract

Incidence of thyroidectomies is continuing to increase. Identifying factors associated with favorable outcomes can lead to cost savings. To assess the association of surgeon volume with clinical outcomes and costs of thyroidectomy. Cross-sectional analysis performed in October of 2014 of adult (≥ 18 years) inpatients in US community hospitals using the Nationwide Inpatient Sample for the years 2003 through 2009. Thyroidectomy. Complications, length of stay, and cost following thyroidectomy in relation to surgeon volume. Surgeon volumes were stratified into low (1-3 thyroidectomies per year), intermediate (4-29 thyroidectomies per year), and high (≥ 30 thyroidectomies per year). A total of 77,863 patients were included. Procedures performed by low-volume surgeons were associated with a higher risk of postoperative complications compared with high-volume surgeons (15.8% vs 7.7%; OR, 1.55 [95% CI, 1.19-2.03]; P = .001). Mean (SD) hospital cost was significantly associated with surgeon volume (high volume, $6662.69 [$409.31]; intermediate volume, $6912.41 [$137.20]; low volume, $10,396.21 [$345.17]; P < .001). During the study period, if all operations performed by low-volume surgeons had been selectively referred to intermediate- or high-volume surgeons, savings of 11.2% or 12.2%, respectively, would have been incurred. On the basis of the cost growth rate, greater savings are forecasted for high-volume surgeons. With a conservative assumption of 150,000 thyroidectomies per year in the United States, referral of all patients to intermediate- or high-volume surgeons would produce savings of $2.08 billion or $3.11 billion, respectively, over a span of 14 years. A surgeon's expertise (measured by surgical volume of procedures per year) is associated with favorable clinical as well as financial outcomes. Our model estimates that considerable cost savings are attainable if higher-volume surgeons perform thyroid procedures in the United States.

Adult

Clinical Competence

Cost Savings

Cross-Sectional Studies

Female

Hospitalization - economics

Hospitalization - statistics & numerical data

Humans

Male

Outcome Assessment (Health Care)

Practice Patterns, Physicians' - economics

Practice Patterns, Physicians' - statistics & numerical data

Thyroid Diseases - etiology

Thyroid Diseases - pathology

Thyroid Diseases - surgery

Thyroidectomy - adverse effects

Thyroidectomy - economics

Thyroidectomy - statistics & numerical data

United States

Details

Title: Subtitle: Association of Surgeon Volume With Outcomes and Cost Savings Following Thyroidectomy: A National Forecast
Creators: Zaid Al-Qurayshi - Tulane University
Russell Robins - Tulane University
Adam Hauch - Tulane University
Gregory W Randolph - Massachusetts Eye and Ear Infirmary
Emad Kandil - Tulane University
Resource Type: Journal article
Publication Details: JAMA otolaryngology-- head & neck surgery, Vol.142(1), pp.32-8
DOI: 10.1001/jamaoto.2015.2503
PMID: 26561736
NLM abbreviation: JAMA Otolaryngol Head Neck Surg
ISSN: 2168-6181
eISSN: 2168-619X
Language: English
Date published: 01/01/2016
Academic Unit: Otolaryngology
Record Identifier: 9984702947302771

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