BACKGROUND
Thyroidectomy, the surgical removal of the thyroid, is one of the most common operations in the US. It is performed for thyroid cancer as well as non-cancer reasons such as benign nodules and hyperthyroidism due to Graves’ disease. Thyroidectomy is generally very safe, but because the thyroid is located in a sensitive area, damage to the structures around it can lead to complications such as voice changes, low calcium levels, or the need for additional treatments. Past research has shown that surgeons who perform a higher number of thyroid surgeries each year tend to have lower complication rates and better overall outcomes. High-volume thyroid surgeons are those that perform >25-100+ operations annually and have better outcomes, lower complication rates and shorter hospital stays as compared to low-volume surgeons. In addition, people with thyroid cancer who have their surgery done by high-volume thyroid surgeons have a lower chance of needing a second operation and may have improved cancer-related outcomes.

However, many thyroid surgeries in the US are performed by surgeons who do very few of these procedures each year. Where a patient lives, their insurance, and other personal factors may affect whether they are treated by a high-volume thyroid surgeon. This study aimed to better understand how these factors influence access to more experienced surgical care.

THE FULL ARTICLE TITLE
Jensen CB, et al. Factors associated with receiving thyroid cancer care from high-volume surgeons. J Am Coll Surg. Epub 2025 Dec 8.

SUMMARY OF THE STUDY
Researchers reviewed data from 2015 to 2022 from a statewide database that includes information from multiple insurers. The database, called Michigan Value Collaborative registry, covers 84% of Michigan’s insured population. They studied adult patients with thyroid cancer who had thyroidectomies. Surgeons were classified as high-volume thyroid surgeons if they did 25 or more thyroid surgeries per year, and as low-volume thyroid surgeons if they did 25 or fewer surgeries per year. The researchers checked patient and neighborhood details, like age, sex, insurance type, estimated income, and education level based on zip code, as well as surgical outcomes and complications after thyroidectomy.

They determined how far patients lived from an endocrinologist, how far they traveled to the treating facility, and to their surgeon. Then, they compared these factors between patients who were treated by high-volume thyroid surgeons and those treated by low-volume thyroid surgeons.

The study included 3,839 patients with thyroid cancer who had thyroidectomy, traveled less than 550 miles for care, and had complete data available. Overall, 46% (1,771) were treated by high-volume thyroid surgeons and 54% by low-volume thyroid surgeons. Patients treated by high-volume thyroid surgeons were slightly younger (53.2 vs 55.6 years), more often female (76.4% vs 70.5%), and more likely to live in areas with higher average income and education levels. They traveled slightly farther for surgery (33.7 vs 28.9 miles) but lived closer to an endocrinologist (10.3 vs 18.3 miles). Patients with Medicare Advantage plans were more likely to be treated by high-volume thyroid surgeons, while those with traditional Medicare, those living in areas with lower education levels, and those living farther from an endocrinologist were less likely to receive care from a high-volume thyroid surgeon. High-volume thyroid surgeons were more likely to do complete thyroid removal and lymph node removal when needed, and complication rates were lower, voice problems (6.3% vs 10.7%), the need for breathing tube (0.2% vs 1.2%), and bleeding after surgery (0.6% vs 2.1%)

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study found that less than half of the patients with thyroid cancer who had thyroid surgery were treated by a high-volume thyroid surgeon. Insurance type, where a person lives, and how close they live to an endocrinologist affected whether they saw a more experienced surgeon. Patients traveled slightly farther to see an high-volume thyroid surgeon. These results are based only on data from Michigan, so more studies in other states are needed. More research is also needed to better understand how patients are referred and decide which surgeon to see. Patients should also keep in mind that, along with their questions about surgery, it is appropriate to ask their referring doctor and surgeon about experience and how their care will be organized.

— Ebru Sulanc, MD

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