• William K Gray, Sebastian Aspinall, Neil Tolley, Jamie Day, and Mark Lansdown.
• Getting It Right First Time Programme, NHS England and NHS Improvement, 1 Lower Marsh, London, SE1 7NT, UK. William.gray5@nhs.net.
• Langenbecks Arch Surg. 2021 Sep 1; 406 (6): 1999-2010.

PurposeThe delivery of surgical care in England has seen a momentum towards centralisation within larger volume hospitals and surgical teams. The aim of this study was to investigate outcomes in England in relationship to hospital and surgeon annual volumes for total thyroidectomy.MethodsData were extracted from the Hospital Episodes Statistics (HES) database for England. A 6-year period (April 2012-March 2018 inclusive) for all adult admissions for thyroidectomy was used in the analysis. The primary outcome measure used was a length of hospital stay greater than 2 days or an emergency readmission within 30 days following surgery. This was used as a proxy for surgical complications. A multilevel modelling strategy was used to adjust for hierarchy and potentially confounding.ResultsData for 22,823 total thyroidectomies across 144 hospital trusts were used for analysis. For total thyroidectomy, larger volume surgeons had reduced levels of post-surgical complications; length of stay > 2 and > 4 days; emergency readmission at 30 days; and hypoparathyroidism, vocal cord palsy, stridor, and tracheostomy at 1-year post-surgery. Larger hospital volume was associated with lower levels of emergency readmission at 30 days and hypoparathyroidism at 1 year.ConclusionsThere is significant correlation between surgeon volume and clinical outcome for total thyroidectomy. The relationship was approximately linear, and a low-volume threshold could not be defined.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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