Abstract
INTRODUCTION: This study describes variability of treatment for differentiated thyroid cancer among thyroid surgeons, in the context of changing patterns of thyroid surgery in the UK.
METHODS: Hospital Episodes Statistics on thyroid operations between 1997 and 2012 were obtained for England. A survey comprising six scenarios of varying 'risk' was developed. Patient/tumour information was provided, with five risk stratified or non-risk stratified treatment options. The survey was distributed to UK surgical associations. Respondent demographics were categorised and responses analysed by assigned risk stratified preference.
RESULTS: From 1997 to 2012, the Hospital Episode Statistics data indicated there was a 55% increase in the annual number of thyroidectomies with a fivefold increase in otolaryngology procedures and a tripling of cancer operations. Of the surgical association members surveyed, 264 respondents reported a thyroid surgery practice. Management varied across and within the six scenarios, and was not related consistently to the level of risk. Associations were demonstrated between overall risk stratified preference and higher volume practice (>25 thyroidectomies per year) (p=0.011), fewer years of consultant practice (p=0.017) and multidisciplinary team participation (p=0.037). Logistic regression revealed fewer years of consultant practice (odds ratio [OR]: 0.96/year in practice, 95% confidence interval [CI]: 0.922-0.997, p=0.036) and caseload of >25/year (OR 1.92, 95% CI: 1.044-3.522, p=0.036) as independent predictors of risk stratified preference.
CONCLUSIONS: There is a substantial contribution to thyroid surgery in the UK by otolaryngology surgeons. Adjusting management according to established case-based risk stratification is not widely applied. Higher caseload was associated with a preference for management tailored to individual risk.
| Original language | English |
|---|---|
| Pages (from-to) | 466-474 |
| Number of pages | 9 |
| Journal | Annals of the Royal College of Surgeons of England |
| Volume | 96 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - 1 Sept 2014 |
Bibliographical note
AcknowledgementsWe wish to thank Professor J MacFie (ASGBI President), Professor N Gair (ASGBI Chief Executive) and Emmanuel Amadiegwu (ASGBI Web/IT Manager) for coordination of survey distribution across the specialty associations. We are also greatful to J Watkinson, A Johnson and D Rainsbury (presidents of BAETS, ENT UK and ABS) for facilitating distribution and endorsement across their associations. Furthermore, we thank Dr A Shaha, Professor T Lennard and D Scott-Coombes for advice in scenario development.
There was no external funding specific to this study. WLC was supported by a Cameron Research Grant from the University of Aberdeen. The Health Services Research Unit (CRR) receives core funding from the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. Views expressed are those of the authors and do not necessarily reflect those of the funders.
Keywords
- cancer
- risk-stratification
- surgery
- thyroid
