Evaluating Surgery Performance and Care Quality in Thyroidectomy

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Clinically severe hypocalcemia, recurrent never injury, and hematoma were observed 30 days after thyroid surgery in 98 hospitals.
Clinically severe hypocalcemia, recurrent never injury, and hematoma were observed 30 days after thyroid surgery in 98 hospitals.

Postoperative hypocalcemia and recurrent laryngeal nerve (RLN) injury among patients undergoing thyroidectomy represent potential measures hospitals can use to evaluate performance and treatment quality, according to findings from a retrospective study published in JAMA Surgery.

Researchers evaluated the variability of thyroidectomy-specific outcomes among hospitals in the American College of Surgeons' National Surgical Quality Improvement Program. Additionally, investigators examined whether adding thyroidectomy-specific factors would have an impact on risk adjustment as well as whether performance-related differences among hospitals correlated with thyroidectomy-specific care processes.

In this study, a total of 14,540 patients who underwent thyroidectomy were included. Of these patients, 755 experienced RLN injury (5.7% overall, 4.2% after partial thyroidectomy, and 6.6% after subtotal or total thyroidectomy), 450 patients experienced clinically severe hypocalcemia (3.3% overall, 0.6% after partial thyroidectomy, and 4.7% after subtotal or total thyroidectomy), and 175 patients (1.3%) experienced hematoma.

For RLN injury and hypocalcemia, hospital performance rankings varied and there was no impact when investigators included thyroidectomy-specific variables in risk adjustment. There were no differences between best- and worst-performing hospitals with regard to measuring hypocalcemia following operation (best- vs worst-performing hospitals, 71.0% vs 68.4%; P =.09).

Best-performing hospitals were less likely to measure postoperative parathyroid hormone level among patients undergoing thyroidectomy vs worst-performing hospitals (593 [19.9%] vs 457 [31.7%], P <.001). In addition, those receiving care at best-performing hospitals were more likely to be prescribed vitamin D, calcium, or both following surgery (2281 [76.6%] vs 962 [66.8%], P <.001).

As related to RLN injury occurrence, best-performing hospitals were also more likely to use energy devices (1517 [69.1%] vs 507 [55.2%], P <.001) and intraoperative nerve monitoring (1223 [55.7%] vs 346 [37.7%], P <.001) compared with worst-performing hospitals.

Generalizability of these findings is difficult because of the predominantly female cohort (79.1%) and because of the small number of hospitals that participated in the study.

The investigators suggest that assessment of hypocalcemia at 30 days may be “important to measure from quality improvement and societal perspectives.”

Reference

Liu JB, Sosa JA, Grogan RH, et al. Variation of thyroidectomy-specific outcomes among hospitals and their association with risk adjustment and hospital performance [published online November 29, 2017]. JAMA Surg. doi:10.1001/jamasurg.2017.4593

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