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Introduction: The COVID-19 pandemic has limited the availability of healthcare resources for non-COVID patients and decreased elective surgeries, including thyroidectomy. Despite the prioritization of surgical procedures, it has been reported that thyroidectomy for thyroid cancer (TCa) was adversely impacted. We assessed the impact of the pandemic on the surgical activities of two high-volume referral centers. Materials and methods: Patients operated at two National Referral Centers for Thyroid Surgery between 03/01/2020 and 02/28/2021 (COVID-19 period) were included (P-Group). The cohort was compared with patients operated at the same Centers between 03/01/2019 and 02/29/2020 (pre-COVID-19 pandemic) (C-Group). Results: Overall, 7017 patients were included: 2782 in the P-Group and 4235 in the C-Group. The absolute number of patients with TCa was not significantly different between the two groups, while the rate of malignant disease was significantly higher in the P-Group (1103/2782 vs 1190/4235) (P < 0.0001). Significantly more patients in the P-Group had central (237/1103 vs 232/1190) and lateral (167/1103 vs 140/1190) neck node metastases (P = 0.001). Overall, the complications rate was significantly lower (11.9% vs 15.1%) and hospital stay was significantly shorter (1.7 ± 1.5 vs 1.9 ± 2.2 days) in the P-Group (P < 0.05). Conclusion: The COVID-19 pandemic significantly decreased the overall number of thyroidectomies but did not affect the number of operations for TCa. Optimization of management protocols, due to limited resource availability for non-COVID patients, positively impacted the complication rate and hospital stay. [ABSTRACT FROM AUTHOR]

Background: For many cancer resections, a hospital volume-outcome relationship exists. The data regarding gastric cancer resection—especially in the western hemisphere—are ambiguous. This study analyzes the impact of gastric cancer surgery caseload per hospital on postoperative mortality and failure to rescue in Germany. Methods: All patients diagnosed with gastric cancer from 2009 to 2017 who underwent gastric resection were identified from nation-wide administrative data. Hospitals were grouped into five equal caseload quintiles (I–V in ascending caseload order). Postoperative deaths and failure to rescue were determined. Results: Forty-six thousand one hundred eighty-seven patients were identified. There was a significant shift from partial resections in low-volume hospitals to more extended resections in high-volume centers. The overall in-house mortality rate was 6.2%. The crude in-hospital mortality rate ranged from 7.9% in quintile I to 4.4% in quintile V, with a significant trend between volume categories (p < 0.001). In the multivariable logistic regression analysis, quintile V hospitals (average of 29 interventions/year) had a risk-adjusted odds ratio of 0.50 (95% CI 0.39–0.65), compared to the baseline in-house mortality rate in quintile I (on average 1.5 interventions/year) (p < 0.001). In an analysis only evaluating hospitals with more than 30 resections per year mortality dropped below 4%. The overall postoperative complication rate was comparable between different volume quintiles, but failure to rescue (FtR) decreased significantly with increasing caseload. Conclusion: Patients who had gastric cancer surgery in hospitals with higher volume had better outcomes and a reduced failure to rescue rates for severe complications. [ABSTRACT FROM AUTHOR]

Background: Many studies showed that hospital and surgeon volume have a significant influence on the complication rates of thyroid surgery. The present study investigates whether this relationship applies in subtotal as well as total lobe resections. Furthermore, it is still unclear which threshold for the hospital-related case volume can be determined, above which the risk of complications lies below the current national average. Material and methods: The study was based on nationwide routine data for persons insured with the Local General Sickness Fund (AOK) who had undergone thyroid surgery in 2014–2016. Permanent vocal cord palsy, bleeding and wound infection needing revision were recorded using indicators. The effect of the case volume on the indicators and the case number threshold was determined using logistic regression. Results: Permanent vocal cord palsy was observed in 1.3% and bleeding or wound infections needing revision in 1.6% and 0.3% of the cases. Compared to hospitals with >450 surgeries per year, the risk of permanent vocal cord palsy in hospitals with fewer than 201, 101 and 51 surgeries was significantly increased (OR [95% CI]: 1.5 [1.1–2.1]; 1.5 [1.1–2.1]; 1.8 [1.3–2.5]). The threshold needed to achieve a risk for permanent vocal cord palsy below the national average (1.3%) was 265 thyroid surgeries per year (95% CI: 110–420). For bleeding or wound infection in need of revision, no association between volume and outcome was found. Conclusion: The present study showed that the risk of postoperative permanent vocal cord palsy decreased with increasing case volume. The broad confidence interval of the threshold makes clear case volume recommendation difficult. In order that the risk for a postoperative permanent vocal cord palsy is not likely above the national average, the annual case volume should reach 110 thyroid interventions. [ABSTRACT FROM AUTHOR]

Hintergrund: In dieser Studie wurden die Häufigkeiten postoperativer Logopädieverordnungen bei Schilddrüsenoperationen anhand deutschlandweiter Routinedaten bestimmt, in den Kontext von Stimmbandlähmungen gesetzt und Volume-Outcome-Zusammenhänge untersucht.Material und Methoden: Datengrundlage bilden bundesweite Routinedaten von AOK-Versicherten, bei denen in den Jahren 2013 bis 2015 eine Schilddrüsenoperation aufgrund einer benignen Schilddrüsenerkrankung durchgeführt wurde. Transiente und permanente Stimmbandlähmungen wurden anhand von Indikatoren und postoperative Logopädie anhand von Heilmittelverordnungen erfasst. Der Effekt des Krankenhausvolumens (Volumenquintile) auf die Verordnung von Logopädie wurde anhand multivariater logistischer Regression bestimmt.Ergebnisse: Es wurden 50.676 Schilddrüsenoperationen identifiziert. Die Häufigkeit postoperativer Logopädieverordnungen betrug 6,5 %. Bei AOK-Fällen mit transienter bzw. permanenter Stimmbandlähmung betrug die Häufigkeit der Verordnungen 56,1 % bzw. 75,2 %. Die Gesamtverordnungsmenge von Logopädie nahm mit zunehmender Dauer der Stimmbandlähmung zu. Die Gesamtverordnungsmenge des Regelfalls (≥21 Einheiten Logopädie) wurde bei 0,7 % der AOK-Fälle überschritten. Gegenüber den fallzahlstärksten Krankenhäusern war das Risiko postoperativer Logopädieverordnungen mit Überschreitung der Gesamtverordnungsmenge des Regelfalls in den beiden fallzahlschwächsten Volumenkategorien signifikant erhöht (Odds Ratios: 1,2 und 1,8).Schlussfolgerung: Die vorliegende Studie stellt die Versorgungsrealität im Hinblick auf die Häufigkeit der Verordnung von Logopädie nach Schilddrüsenoperationen in Deutschland dar. Zusätzlich wurde festgestellt, dass das Risiko einer postoperativen logopädischen Therapie mit Überschreitung der Gesamtverordnungsmenge des Regelfalls mit wachsender Fallzahlstärke des behandelnden Krankenhauses sinkt. [ABSTRACT FROM AUTHOR]

Background: Routine data from hospitals in the public healthcare system allow the analysis of large patient datasets without generating additional documentation efforts for hospitals. This study reports the frequencies of postoperative complications after thyroid surgery based on routine nationwide data. Moreover, volume-outcome relationships were investigated. Material and methods: Nationwide routine data from insured patients of the Local Health Insurance Fund (AOK) who underwent thyroid surgery between 2008 and 2010 were analyzed. Complications were determined based on indicators for permanent vocal cord palsy, re-bleeding with re-operations and wound infections with specific treatment. The effect of hospital volumes (volume quintiles) on the indicators was determined by multivariate logistic regression. Results: A total of 66,902 thyroid gland operations were identified. The overall frequency of permanent vocal cord palsy was 1.5 %, re-bleeding 1.8 % and wound infections 0.4 %. In the four lowest case volume categories the risk of permanent vocal cord palsy was significantly higher compared to the highest case volume hospitals (odds ratio 1.5, 1.7, 1.7 and 2.2, respectively). Conclusion: This study represents the reality of healthcare for thyroid surgery in Germany. Additionally, it was determined that the risk for permanent vocal cord palsy after thyroid gland operations decreased with increasing case volumes of hospitals. [ABSTRACT FROM AUTHOR]

Esophageal cancer incidence is rapidly increasing in the western countries. Adenocarcinoma has recently become the most frequent subtype because of the changes in lifestyle. As observed for other types of surgery, even for esophageal surgery better results have been observed in centers with high volume of activity. Countries with formal policies of centralization, as Great Britain and The Netherlands, have got lower mortality and longer survival than those obtained before the centralization program introduction and of those countries without centralization programs. However, concerns about accessibility to high volume hospitals for lower level social strata have emerged in different countries. In Italy most of the esophagectomies for cancer are performed in very low volume centers with limited experience. High volume centers with > 20 cases/ year are few but, even if managing patients with more severe comorbidities have got a lower mortality and a shorter length of stay. The Aim of this paper is to identify the organizational, structural and volume requirements for accreditation of a center as an esophageal surgery center. Special attention must be given to a multidisciplinary approach involving different highly skilled specialists with the creation of a multidisciplinary team and individualized diagnostic and therapeutic pathways. [ABSTRACT FROM AUTHOR]

Background: It is unknown whether a volume-outcome relationship exists for mechanically ventilated admissions to UK critical care units. This study was conducted to evaluate the volume-outcome relationship for mechanically ventilated admissions to adult, general critical care units in the UK with a view to informing policy, service delivery and organisation of specialist, advanced respiratory care. Methods: A retrospective cohort study using data from the Case Mix Programme Database was conducted. The primary exposure of interest was annual volume (absolute number) of mechanically ventilated admissions per critical care unit per year. The primary outcome was ultimate acute hospital mortality. A multivariable analysis was performed to assess the relationship between annual volume and outcome while adjusting for a priori selected confounders. Two interaction tests were performed. The first interaction test was between annual volume and admission type and the second between annual volume and initial acute severity of respiratory failure. Sensitivity analysis excluding volume outlier units and using restricted cubic splines to model volume was also performed. Results: After adjusting for confounding, there was a significant relationship between annual volume and ultimate acute hospital mortality ( p < 0.02). The first interaction test revealed a strong interaction between annual volume and admission type, with a more pronounced volume-outcome relationship for non-surgical admissions ( p < 0.001). The second interaction test between annual volume and initial acute severity of respiratory failure was not statistically significant ( p = 0.12). The analysis using restricted cubic splines demonstrated a similar graphical relationship but the results were not statistically significant ( p = 0.87). Conclusions: A volume-outcome relationship was demonstrated for mechanically ventilated admissions to adult, general critical care units in the UK. The relationship is sensitive to the modelling approach used. [ABSTRACT FROM AUTHOR]