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Pediatric thyroid cancer patients referred to high-volume facilities have improved short-term outcomes.

Pediatric thyroid cancer patients referred to high-volume facilities have improved short-term outcomes.
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Youngwirth LM, Adam MA, Thomas SM, Roman SA, Sosa JA, Scheri RP,


Youngwirth LM, Adam MA, Thomas SM, Roman SA, Sosa JA, Scheri RP, (click to view)

Youngwirth LM, Adam MA, Thomas SM, Roman SA, Sosa JA, Scheri RP,

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Surgery 2017 11 22163(2) 361-366 pii 10.1016/j.surg.2017.09.042

Abstract
BACKGROUND
Thyroid cancer is the most common endocrine malignancy in children, albeit still rare. This study sought to measure the association between outcomes and case volume of the treatment facility for pediatric patients with thyroid cancer.

METHODS
The National Cancer Data Base (1998-2011) was queried for all pediatric patients (age ≤ 18 years) with thyroid cancer. Demographic, clinical, and pathologic features were evaluated for all patients. Case volume of the treating facility was defined as the number of pediatric thyroid cancer patients at that facility during the study period. Restricted cubic spline modeling was used to determine a volume threshold associated with decreased risk of 30-day readmission. Patients were assigned to volume groups based on this threshold. Logistic regression was utilized to estimate the effect of volume on 30-day readmission.

RESULTS
In total, 4,466 patients met inclusion criteria. The majority were girls (79.1%), white (86.1%), and underwent total thyroidectomy (86.9%). Compared with patients treated at the low-volume facilities, those treated at the high-volume facilities were more likely to have medullary thyroid cancer (10.7% versus 3.7%) and undergo total thyroidectomy (90.8% versus 86.3%) (all P < .01). After adjustment, treatment at low-volume facilities was associated with an increased likelihood of readmission after operative treatment (odds ratio = 3.52, P = .01). CONCLUSION
Pediatric patients with thyroid cancer treated at low-volume facilities are more likely to be readmitted after thyroid surgery than patients treated at high-volume facilities. Providers should consider the case volume status at the treating facility when referring these children for thyroid surgery.

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