Children who need thyroid surgery have better results in high volume surgery centers

New research recently published in the Journal of Pediatric Surgery found that postoperative success rates of pediatric thyroid patients, particularly children requiring thyroidectomy, correlated with the volume of patients in the facility. The study, conducted by a team at the Children's Hospital of Philadelphia (CHOP), examined nearly 500 cases. The results highlight how a highly experienced clinical team can make a big difference in patient outcomes.

Since thyroid diseases are less common in children than adults, pediatric surgery specialists often have less experience with the management of thyroid disease. Other studies have shown an increased risk of complications for children undergoing thyroid surgery, with patients being about 3.5 times more likely than adults to be readmitted and receive non-compliant care. national guidelines. Surgery is often a necessity for many patients, as for patients with thyroid cancer where surgical removal of the thyroid and regional lymph nodes is the most important initial step care after confirming the diagnosis by fine needle biopsy. Surgery is also commonly performed in patients with Graves 'disease, an autoimmune disease that causes hyperthyroidism (overactive thyroid), as less than 30% of pediatric patients with Graves' disease achieve remission.

"The CHOP's Pediatric Thyroid Center is the busiest center of its kind in the United States," said N. Scott Adzick, MD, chief CHOP surgeon and lead author of the study. "Our highly trained team performs at least 80 thyroid surgeries each year, as well as evaluating and managing the care of hundreds of patients." We wanted to measure the benefits of being in a high-volume, high-volume center. examine what this meant for the results obtained for patients before and after surgery. "

The study team reviewed the medical records of 464 pediatric patients undergoing thyroid surgery at CHOP between 2009 and 2017. Data collection focused on pathologic diagnosis, surgical technique and complications. surgical. These patients were diagnosed with papillary or follicular thyroid cancer (n = 168), benign modules (n = 151), Graves' disease (n = 124), and medullary thyroid cancer (n = 14) and seven patients underwent prophylactic multiple endocrine neoplasia type 2A (MEN2a) thyroidectomy, characterized by medullary carcinoma of the thyroid. Papillary thyroid cancer surgery included lymph node dissection depending on the extent of the disease.

The rates of complications after thyroidectomy in 464 pediatric patients are the lowest ever reported. Only two patients had a persistent recurrent laryngeal nerve deficit six months after the operation (0.4%) and two patients had persistent hypoparathyroidism six months after total thyroidectomy (0.6%). There was no significant difference between hypocalcemia and hypoparathyroidism after total thyroidectomy depending on the age of the patient or the diagnosis.

"We have reported extremely low complication rates after surgery, stressing that an intensive treatment center with specialized pediatric surgeons and well-versed in these procedures should be considered for children and adolescents requiring surgery for a thyroid disease, "said Andrew J. Bauer, MD. an endocrinologist and medical director of CHOP's thyroid pediatric center and one of the co-authors of the study. "By seeing more patients, our team is extremely competent to ensure a complete and accurate preoperative badessment and to select the best surgical plan for each patient based on their diagnosis.This approach is badociated with the optimization of results while maintaining reduced complications for our patients and their families. "