This is the first study to identify a surgeon volume threshold (>25 total thyroidectomies/y) that is associated with improved patient outcomes. Identifying a threshold number of cases defining a high-volume thyroid surgeon is important, as it has implications for quality improvement, criteria for referral and reimbursement, and surgical education.
Establishing a definition for a high-volume thyroid surgeon serves as a critical first step toward improving organization of patient care and training around thyroidectomy at a regional or national level, potentially bearing significant implications regarding qualityimprovement initiatives, identification of criteria for referral and payer reimbursement, and surgical education. This volume threshold is also important for patients and referring physicians. Surgeons are generally aware of how many procedures they perform per year; in addition, with maintenance of certification and recertification requirements, they also must be able to report their outcomes.
Patients should be able to ask a surgeon directly how many thyroidectomies they perform, on average, per year. Surgeons have an ethical responsibility to be honest and report their own case numbers. Whereas previous attempts at implementation of high-volume care have not been well-embraced by small hospitals, the anticipated departure from the current model of fee-for-service to value-based reimbursement may shift the focus to volume-based practice, as the financial risks from complications will be imposed on hospitals.
In areas where access to high-volume surgeons is problematic, providers and hospital administrators could potentially designate a surgeon(s) to perform all thyroidectomies within a small practice. As such, these data potentially have important implications for patients, referring providers, surgeons, hospitals, and payers.