Avoidable reoperations for thyroid and parathyroid surgery: Effect of hospital volume

Background. Hospital volume for thyroid and parathyroid surgery inversely correlates with perioperative complications. This correlation has not been made regarding the need for reoperation. Methods. We retrospectively analyzed 395 reoperative thyroid (TR) and parathyroid (PR) surgeries at a tertiary care hospital from 1999 to 2007. Based on current standards of care, reoperations were classified as avoidable or unavoidable. Public discharge data were used to classify hospitals as low-volume centers (LVC; <20 cases/yr) or high-volume centers (HVC; >= 20 cases/yr). The chi(2) test was used to determine statistical significance. Results. Hospital data were available for 335 reoperations (85%). There were 134 avoidable (34%) and 201 unavoidable (66%) procedures. Primary hyperparathyroidism (HPT) and thyroid cancer each accounted for a third of cases. Of PR from LVC, 77% were avoidable compared with 22% from HVC (P < .001). Of TR from LVC, 50% were avoidable versus 14% from, HVC (P < .001). Operations for both primary HPT and thyroid cancer led to avoidable reoperations more frequently if performed at a LVC (P < .001). Conclusion. By objective criteria, many thyroid and parathyroid reoperations are avoidable. Most originate front LVC. In addition to decreasing complication rates, thyroid and parathyroid surgery performed at HVC would decrease the need for patients to undergo reoperations. (Surgery 2008; 144:899-907.)