The Effect of Specialization on Postoperative Complications in Thyroid Surgery

Objective: The relationship between the surgeon's experience/volume of performed operations and postoperative results of thyroid surgery is a pressing issue that has been widely discussed in recent publications.This study aimed to compare the complication rates in thyroidectomy operations performed before and after specialization and evaluate the effect of specialization on the outcomes of thyroid surgeries.Methods: The study included patients who had undergone thyroidectomy with or without neck dissection due to benign or malign thyroid diseases in a single tertiary reference hospital between April 2013 and March 2017.The patients were divided into two groups: those who were operated on before specialization (BS) and after specialization (AS).Age, gender, operation type, postoperative hypocalcemia, incidental parathyroidectomy, recurrent laryngeal nerve (RLN) injury, and postoperative bleeding or hematoma were compared between the groups.Results: Of the thyroid patients, 776 were operated on (367 (47%) and 409 (53%) of the BS and AS groups, respectively).No significant difference was found between the two groups regarding the postoperative Ca 2+ level, while the parathormone was significantly lower in the BS group (p=0.2 and p=0.02, respectively).In addition, postoperative transient hypocalcemia was significantly less common in the AS group (p<0.001).The incidental parathyroidectomy rate was significantly higher in the BS group (p<0.01).Postoperative transient hoarseness developed in 15 (4%) patients in the BS group and in 2 (0.5%) patients in the AS group.Twelve patients had unilateral vocal cord paralysis, all of whom were in the BS group (p<0.01).No significant difference exists between the groups regarding bleeding (p=0.5). Conclusion:This study indicated that specialization in thyroid surgery significantly reduced complications (e.g., hypocalcemia, incidental parathyroidectomy, and RLN injury).