ESPE Abstracts

Background: A positive relationship between an individual surgeon’s operative volume and clinical outcomes after paediatric and adult thyroidectomy is well-established. The impact of a hospital’s paediatric operative volume on surgical outcomes and healthcare utilisation, however, are infrequently reported. We investigated associations between hospital volume and healthcare utilisation outcomes following paediatric thyroidectomy in Canada’s largest province, Ontario, using population-level data.

Methods: Retrospective analysis of administrative and health-related population-level data from 1993 to 2017; a province-wide single-payor insurance system permits sampling the entire population. A cohort of 1,908 pediatric (<18 years) index thyroidectomies was established. Hospital volume was defined per-case as thyroidectomies performed in the preceding year. Healthcare utilization outcomes: length of stay (LOS), same day surgery (SDS), readmission, and emergency department (ED) visits were measured. Multivariate analysis adjusted for patient-level, disease and hospital-level co-variates.

Results: Mean age at surgery was 10.4 ± 5.4 years, 61% female and 20% had a cancer diagnosis. Hospitals with the lowest volume of paediatric thyroidectomies, accounted for 30% of thyroidectomies province-wide and performed 0-1 thyroidectomies/year. The highest-volume hospitals performed 19-60 cases/year. LOS was 0.64 days longer in the highest, versus the lowest quartile. SDS was 83% less likely at the highest, versus the lowest quartile. Hospital volume was not associated with rate of readmission or ED visits. Increased ED visits were, however, associated with male sex, increased material deprivation, and rurality.

Conclusions: Increased hospital paediatric surgical volume was associated with increased LOS and lower likelihood of SDS. This may reflect patient complexity at such centres. In this cohort, low-volume hospitals were not associated with poorer healthcare utilisation outcomes. Further study of groups disproportionately accessing the ED post-operatively may help direct resources to these populations.