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Determinants of operative time in thyroid surgery: A prospective multicenter study of 3454 thyroidectomies.

ABSTRACT: To identify the determinants of operative time for thyroidectomy and quantify the relative influence of preoperative and intra-operative factors.Anticipation of operative time is key to avoid both waste of hospital resources and dissatisfaction of the surgical staff. Having an accurate and anticipated planning would allow a rationalized operating room use and may improve patient flow and staffing level.We conducted a prospective, cross-sectional study between April 2008 and December 2009. The operative time of 3454 patients who underwent thyroidectomy performed by 28 surgeons in five academic hospitals was monitored. We used multilevel linear regression to model determinants of operative time while accounting for the interplay of characteristics specific to surgeons, patients, and surgical procedures. The relative impact of each variable on operative time was estimated.Overall, 86% (99% CI 83 to 89) of operative time variation was related to preoperative variables. Surgeon characteristics accounted for 32% (99% CI 29 to 35) of variation, center location for 29% (99% CI 25 to 33), and surgical procedure or patient variables for 24% (99% CI 20 to 27). Operative time was significantly lower among experienced surgeons having practiced from 5-19 years (-21.8 min, P<0.05), performing at least 300 thyroidectomies per year (-28.8 min, P<0.05), and with increasing number of thyroidectomies performed the same day (-11.7min, P<0.001). Conversely, operative time increased in cases of procedure supervision by a more experienced surgeon (+20.0 min, P<0.001). The remaining 13.0% of variability was attributable to unanticipated technical difficulties at the time of surgery.Variation in thyroidectomy duration is largely explained by preoperative factors, suggesting that it can be accurately anticipated. Prediction tools allowing better regulation of patient flow in operating rooms appears feasible for both working conditions and cost management.

SUBMITTER: Patoir A

PROVIDER: S-EPMC5531561 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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Project description:BackgroundLongitudinal studies on functional outcome after colon resection are limited.ObjectiveExamine bowel dysfunction and related distress one and three years after colon resection utilizing the low anterior resection syndrome score as well as specific validated items.DesignThis study presents the long-term results of bowel dysfunction and related distress based on the quality of life in colon cancer study, an observational, prospective multicenter study of patients with newly diagnosed colon cancer.SettingsThe study was conducted at 21 Swedish and Danish surgical centers between 2015 and 2019.PatientsAll patients who underwent right- or left-sided colon resection were considered eligible. Exclusion criteria were age below 18, cognitive impairment or inability to understand Swedish/Danish. Patients completed extensive questionnaires at diagnosis, and after one and three years. Clinical data were supplemented by national quality registries.Main outcome measuresThe low anterior resection syndrome score, specific bowel symptoms and the patient-reported distress were assessed.ResultsOf 1,221 patients (83% response rate), 17% reported major LARS one year after either type of resection, consistent at 3 years (17% right, 16% left). In the long-term, the only significant difference between types of resection was a high occurrence of loose stools following right-sided resections. Overall, less than one-fifth of patients experienced distress, with women reporting more frequent symptoms and greater distress. In particular, incontinence and loose stools correlated strongly with distress.LimitationsAbsence of pre-diagnosis bowel function data.ConclusionsOur study indicates that bowel function remains largely intact following colon resection, with only a minority reporting significant distress. Adverse outcomes were more common among women. The occurrence of loose stools following right-sided resection and the association between incontinence, loose stools, and distress highlights a need for postoperative evaluations and more thorough assessments beyond the LARS score when evaluating colon cancer patients. See Video Abstract.

Project description:BackgroundThe occurrence of thyroid nodules and goiter increases with age. In general, surgery age is a predictor of perioperative morbidity. In thyroid surgery, there are different data on the role of age on morbidity. We investigated the influence of age on the outcome in thyroid surgery in a prospective single cohort study with a follow-up after 1 year.MethodsTotal thyroidectomy or hemithyroidectomy was performed in euthyroid benign thyroid goiters (n=152). The primary endpoint was surgery duration. The secondary endpoints were weight of resected tissue, body mass index (BMI), amount and type of perioperative and long-term complications, and quality of life (QoL) preoperatively and 1 year postoperatively.ResultsA significant three-way interactive relationship between age, surgery duration, and amount of resected tissue was found. An increase in any of these variables results in an increase in both other variables. The amount of perioperative complications was associated with resected tissue size. The QoL increases significantly after surgery by up to 10% and decreases significantly with age (mean QoL after surgery=84.9 of 100 for the youngest group and 75.7 of 100 for the oldest group). No long-term complications were recorded.ConclusionThe number of thyroid operations, especially of benign thyroid goiters, decreases annually in Germany. This can be explained by the fact that, on the one hand, the surgical indications are made more restrictive as conspicuous nodes are better clarified by improved technical aids. On the other hand, conservative measures (i.e. L-thyroxine and iodide administration) are used to achieve a size regimen of the goiter. Our results show that perioperative complications increase with patients' age and surgery duration. However, the more restrictive surgical decision also entails the risk that patients will have to be operated at an older age and possibly with a bigger goiter, which is associated with higher operative morbidity. Therefore, in addition to the possibility of conservative therapy of the symptomatic goiter, the affected patients should also be thoroughly informed about the option to perform elective early thyroid surgery with regard to improved postoperative QoL and to keep the overall stress at a minimum for elderly patients.

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Determinants of operative time in thyroid surgery: A prospective multicenter study of 3454 thyroidectomies.

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