6. Outcomes of surgery - AAES GUIDELINES
The AAES guidelines quote numerous studies presenting evidence that the outcomes from thyroid surgery for both benign disorders and thyroid cancer are significantly better in the high volume units where surgery is performed by surgeons with a large operative experience. They point to an analysis across the USA over ten years that found a volume threshold of >25 thyroid procedures was associated with improved outcomes including reduced complications and lower length of hospital stay. Surgeons who treat more than 30 thyroid cancers each year had better cancer outcomes in relation to achieving a complete resection of the cancer.
Comment: In addition to the usual complications of any surgical procedure such as reactions to anaesthetics, bleeding and infection, thyroid surgery is associated with specific complications ass a result of local anatomical factors. These are more common following total thyroidectomy and include damage to the recurrent laryngeal nerves causing voice changes or even tracheostomy if both nerves are damaged, damage to the parathyroid glands causing hypoparathyroidism and the need for lifelong calcium tablets. These complications are seen in less than 1% of cases when surgery is performed in high volume units, however surgeons who only perform the occasional thyroid operation can have complication rates exceeding 20%