COMMENTARY

Does More Experience Equal a Better Thyroidectomy?

Albert B. Lowenfels, MD

April 25, 2012

Influence of Experience on Performance of Individual Surgeons in Thyroid Surgery: Prospective Cross Sectional Multicentre Study

Duclos A, Peix JL, Colin C, et al; CATHY Study Group
BMJ. 2012;344:d8041. doi: 10.1136/bmj.d8041

Summary

What factors are associated with adverse events during thyroidectomy? The authors looked at outcomes of 3574 thyroid procedures performed by 28 surgeons in 5 French referral centers. The overall rates for laryngeal nerve injury and hypoparathyroidism were 2.1% and 2.7%, respectively. Multivariate analysis revealed that the most significant factor leading to an adverse outcome was the surgeon's number of years in practice. Patients operated on by surgeons with more than 20 years of practice had a 3-fold increased risk for recurrent laryngeal nerve injury (P = .04) and a 7.6-fold increased risk for hypoparathyroidism (P = .01). Patients operated on by surgeons with less than 5 years of experience also had higher rates of adverse events.

Viewpoint

The relationship between attributes such as age of the surgeon and outcome has not received a great deal of attention. This report, which examined the relationship between surgical experience and outcome after thyroidectomy in high volume referral centers, found that the age-outcome relationship was concave, with higher complication rates in younger, less experienced surgeons as well as the older group of surgeons. Higher risk in younger surgeons can be correlated with lack of experience, and perhaps older, more experienced surgeons have higher complication rates because they operate on more complex patients or because they have competing administrative concerns. However, for thyroid surgery, this report emphasizes that peak performance for this operation is found mid-career and diminishes after about 2 decades.

Abstract