Volume and experience are the keys to success when it comes to pediatric thyroid surgeries, according to a new report.
The study, published in the Journal of Pediatric Surgery, found that pediatric thyroid surgeries—which are not all that common—have better outcomes when performed at facilities that do a lot of them.1
The study, conducted at the Children’s Hospital of Philadelphia (CHOP), reviewed nearly 500 cases of children who underwent thyroid surgeries at CHOP between 2009 and 2017. Researchers assessed diagnoses, surgical techniques used, and surgical complications that followed the procedures. Most children who had surgical thyroid interventions had papillary or follicular thyroid cancer, followed by benign nodules, Graves disease, medullary thyroid cancer, and multiple medullary carcinoma of the thyroid.
The team found very low complication rates among the patients at CHOP—0.4% with persistent recurrent laryngeal nerve deficit at six months and 0.6% with persistent hypoparathyroidism six months after thyroidectomy. The study concluded it was the high volume and practiced expertise of the surgical teams at CHOP—a high-volume center when it comes to thyroid surgeries—that contributed to this success.
Right place, right surgeon matters
Andrew J. Bauer, MD, an endocrinologist, medical director of the Pediatric Thyroid Center at CHOP, and one of the co-authors of the study, says where a surgery is performed and by whom appears key to a good outcome.
“Having the right surgeon perform the surgery is the most important first step in treating patients with thyroid nodules and thyroid cancer, as well as for patients that select thyroidectomy for definitive treatment of Graves disease,” says Bauer. “Because disease-specific mortality for thyroid disease in children and adolescents is low, reducing the risk of treatment-associated complications is critical to optimize long-term outcomes and quality of life.”
Bauer says there really is no secret treatment plan to optimize treatment outcomes during these types of surgeries. “It comes down to basics, to building a comprehensive, multidisciplinary team invested in improving the lives of pediatric patients with thyroid disease,” he says. “Having a highly skilled thyroid surgeon is critical, but the surgeon is one member of the team. The greater the knowledge and experience of the team, the more accurate and complete the evaluation and plan, and the lower the rate of complications.”
1. Baumgarten HD, Bauer AJ, Isaza A, Mostoufi-Moab S, Kazahaya K, Adzick NS. Surgical management of pediatric thyroid disease: complication rates after thyroidectomy at the Children’s Hospital of Philadelphia high-volume Pediatric Thyroid Center. J Pediatr Surg. February 28, 2019. Epub ahead of print.