Pediatric endocrine surgery: who is operating on our children?

Surgery. 2008 Dec;144(6):869-77; discussion 877. doi: 10.1016/j.surg.2008.08.033.


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.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Female
  • General Surgery*
  • Humans
  • Infant
  • Infant, Newborn
  • Length of Stay
  • Male
  • Parathyroid Diseases / surgery*
  • Parathyroidectomy / economics
  • Parathyroidectomy / statistics & numerical data*
  • Thyroid Diseases / surgery*
  • Thyroidectomy / economics
  • Thyroidectomy / statistics & numerical data*
  • Workforce