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Influence of experience on performance of individual surgeons in thyroid surgery: prospective cross sectional multicentre study

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.d8041 (Published 11 January 2012) Cite this as: BMJ 2012;344:d8041
  1. Antoine Duclos, assistant professor of public health1211,
  2. Jean-Louis Peix, professor of surgery3,
  3. Cyrille Colin, professor of public health12,
  4. Jean-Louis Kraimps, professor of surgery4,
  5. Fabrice Menegaux, professor of surgery5,
  6. François Pattou, professor of surgery67,
  7. Fréderic Sebag, professor of surgery8,
  8. Sandrine Touzet, senior epidemiologist12,
  9. Stéphanie Bourdy, project manager12,
  10. Nicolas Voirin, biostatistician910,
  11. Jean-Christophe Lifante, professor of surgery3
  12. The CATHY Study Group*
  1. 1Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon F-69003, France
  2. 2Université de Lyon, Equipe d’Accueil Mixte 4128 Santé-Individu-Société, Lyon F-69002
  3. 3Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service de Chirurgie Générale et Endocrinienne, Pierre Bénite, Lyon
  4. 4Department of Endocrine Surgery, Poitiers University, Jean Bernard Hospital, Poitiers, France
  5. 5Assistance Publique-Hôpitaux de Paris, Hôpital la Pitié-Salpêtrière, Service de Chirurgie Générale, Viscérale et Endocrinienne, Paris, France
  6. 6Centre Hospitalier Régional Universitaire de Lille, Chirurgie Générale et Endocrinienne, Lille, France
  7. 7Université Lille Nord de France, Institut National de la Santé et de la Recherche Médicale (INSERM), Lille
  8. 8Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire la Timone-Adulte, Marseille, France
  9. 9Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d’Hygiène, Epidémiologie et Prévention, Lyon
  10. 10Centre National de la Recherche Scientifique (CNRS), Unite Mixte de Recherche 5558, Laboratoire de Biométrie et Biologie Evolutive, Université de Lyon, Lyon
  11. 11Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
  1. Correspondence to: A Duclos antoineduclos{at}yahoo.fr
  • Accepted 20 October 2011

Abstract

Objective To determine the association between surgeons’ experience and postoperative complications in thyroid surgery.

Design Prospective cross sectional multicentre study.

Setting High volume referral centres in five academic hospitals in France.

Participants All patients who underwent a thyroidectomy undertaken by every surgeon in these hospitals from 1 April 2008 to 31 December 2009.

Main outcome measures Presence of two permanent major complications (recurrent laryngeal nerve palsy or hypoparathyroidism), six months after thyroid surgery. We used mixed effects logistic regression to determine the association between length of experience and postoperative complications.

Results 28 surgeons completed 3574 thyroid procedures during a one year period. Overall rates of recurrent laryngeal nerve palsy and hypoparathyroidism were 2.08% (95% confidence interval 1.53% to 2.67%) and 2.69% (2.10% to 3.31%), respectively. In a multivariate analysis, 20 years or more of practice was associated with increased probability of both recurrent laryngeal nerve palsy (odds ratio 3.06 (1.07 to 8.80), P=0.04) and hypoparathyroidism (7.56 (1.79 to 31.99), P=0.01). Surgeons’ performance had a concave association with their length of experience (P=0.036) and age (P=0.035); surgeons aged 35 to 50 years had better outcomes than their younger and older colleagues.

Conclusions Optimum individual performance in thyroid surgery cannot be passively achieved or maintained by accumulating experience. Factors contributing to poor performance in very experienced surgeons should be explored further.

Footnotes

  • Members of the CATHY Study Group: Laurent Arnalsteen, Robert Caizzo, Bruno Carnaille, Guelareh Dezfoulian, Carole Eberle, Ziad El Khatib, Emmanuel Fernandez, Antoine Lamblin, François Pattou, and Marie-France Six (Lille); Stéphanie Bourdy, Laetitia Bouveret, Cyrille Colin, Antoine Duclos, Benoît Guibert, Marie-Annick Le Pogam, Jean-Christophe Lifante, Jean-Louis Peix, Gaétan Singier, Pietro Soardo, Sandrine Touzet, and Nicolas Voirin (Lyon); Pascal Auquier, Jean-François Henry, Claire Morando, Frédéric Sebag, and Sam Van Slycke (Marseille); Inès Akrout, Fares Benmiloud, Jean-Paul Chigot, Isabelle Colombet, Gaëlle Godiris-Petit, Pierre Leyre, Fabrice Ménégaux, Séverine Noullet, Benoît Royer, and Christophe Tresallet (Paris); Thibault Desurmont, Claudia Dominguez, Jean-Louis Kraimps, Chiara Odasso, and Laetitia Rouleau (Poitiers); Yves-Louis Chapuis, Pierre Durieux, Alain Lepape, and Frédéric Triponez (scientific committee). We thank Kathy Corso (Boston) for reviewing the English language in the paper.

  • Contributors: AD and JCL obtained funding and supervised the study. AD, CC, FM, FP, FS, JCL, JLK, JLP, and ST conceived and designed the study. CC, FM, FP, FS, JCL, SB, JLK, and JLP were responsible for data acquisition and provided administrative, technical, or material support. AD, JCL, NV, and SB analysed and interpreted the data. AD, JCL, and NV drafted the manuscript. AD, CC, FM, FP, FS, JCL, JLK, JLP, NV, SB, and ST revised the manuscript critically. All authors approved the final version of the manuscript to be published. AD is guarantor. All authors had full access to the data and take responsibility for its integrity and the accuracy of the analysis.

  • Funding: This study was supported by a grant from the Programme de Recherche en Qualité Hospitalière 2007 of the French Ministry of Health (Ministère chargé de la Santé, Direction de l’Hospitalisation et de l’Organisation des Soins), Hospices Civils de Lyon, Lyon. The funding source had no involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Researchers were independent from the funder.

  • Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: that all authors received support from the French Ministry of Health for the submitted work; no relationships with any company that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was approved by the Research Committee for the Protection of Persons and the National Advisory Committee on Information Processing in Material Research in the Field of Health in accordance with ethical directives, in France.

  • Patient consent: Informed consent was obtained from participating surgeons and all patients for sharing their data.

  • Data sharing: No additional data available.

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