Associations of Volume and Thyroidectomy Outcomes: A Nationwide Study with Systematic Review and Meta-Analysis

Otolaryngol Head Neck Surg. 2016 Jul;155(1):65-75. doi: 10.1177/0194599816634627. Epub 2016 Mar 1.


Objective: This study explored how different hospital volumes and surgeon volumes affect thyroidectomy outcomes in terms of length of stay (LOS), costs, and in-hospital mortality.

Data sources: MEDLINE and EMBASE databases.

Review methods: This study retrospectively analyzed a cohort of 125,037 thyroidectomy patients treated at Taiwan hospitals from 1996 to 2010. Relationships between hospital/surgeon volume and patient outcomes were retrospectively analyzed by propensity score matching. In conjunction with the retrospective study, a systematic review and meta-analysis of the relevant literature also were performed.

Results: The mean LOS for all thyroidectomies performed during the study period was 3.3 days, and the mean cost was $1193.5. Both high-volume hospitals and high-volume surgeons were associated with significantly shorter LOS and lower costs compared with their low-volume counterparts (P < .001). Different volume groups had similar in-hospital mortality rates. The meta-analysis results consistently showed that the benefits of high-volume hospitals/surgeons are reduced LOS and costs. However, low in-hospital mortality rates were associated with high-volume surgeons but not with high-volume hospitals.

Conclusions: This meta-analysis showed that patients who received thyroidectomies performed by high-volume hospitals and surgeons had shorter LOS and lower costs compared with those treated by low-volume hospitals and surgeons. In addition, in-hospital survival rates were better in patients treated by high-volume surgeons. Further research is needed to define the learning curve for thyroidectomy and to clarify how hospital volume and surgeon volume affect its success rate.

Keywords: hospital costs; length of stay; survival; thyroidectomy; volume.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Hospital Costs
  • Hospital Mortality
  • Hospitalization / economics
  • Hospitalization / statistics & numerical data
  • Hospitals, High-Volume
  • Hospitals, Low-Volume
  • Humans
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data
  • Propensity Score
  • Retrospective Studies
  • Survival Rate
  • Taiwan
  • Thyroidectomy* / economics
  • Thyroidectomy* / statistics & numerical data