Does Surgeon Volume Impact Morbidity Following Parathyroidectomy? A Study of 16,140 Parathyroidectomies from the UK Registry of Endocrine and Thyroid Surgery (UKRETS) Database.

BACKGROUND: Outcomes in endocrine surgery have been shown to improve with surgeon volume. We aimed to study the effect of surgeon volume on morbidity following parathyroidectomy. METHODS: UKRETS data from 2004 to 2019 was studied. Parathyroidectomies for primary hyperparathyroidism with complete data were included. Exclusion criteria were age <18 or >80 years; surgeons contributing <10 cases overall; and length of stay >28 days. Multivariable analysis was performed. Primary outcome was persistent hypercalcaemia; secondary outcomes were haemorrhage, length of stay, need for re-admission, post-operative hypocalcaemia, and need for calcium/vitamin D supplements to maintain eucalcaemia at 6 months. RESULTS: 153 surgeons undertook mean 22.5 (median 17, range 2-115) parathyroidectomies/year. Persistent hypercalcaemia affected 4.8% (776/16140) overall; 5.7% (71/1242) in surgeons undertaking < 10 cases/year; 5.1% (3339/6617) for 10-30 cases/year; 5.0% (270/5397) for 30-50 cases; and 3.3% (96/2884) for >50 cases/year. High-volume (>50 parathyroidectomies/year) surgeons operated 23.4% (809/3464) of negative localisation cases compared to 16.4% (2074/12676) of positive localisation cases. Persistent hypercalcaemia was almost twice as common in image negative (7.9%) compared to image-positive (4%) cases. Persistent hypercalcaemia was significantly more likely to occur in the low volume (<10 parathyroidectomies/year) group than high volume (>50 parathyroidectomies/year), regardless of image positivity (p = 0.0006). Surgeon volume significantly reduced persistent hypercalcaemia on multivariable analysis (OR = 0.878, 95%CI 0.842-0.914, p < 0.001), along with age, sex, and positive localisation. BNE and re-operation significantly increased persistent hypercalcaemia. Post-operative hypocalcaemia occurred in 3.2% (509/16040) and was reduced with increasing surgeon volume (OR = 0.951, 95%CI 0.910-0.993, p < 0.001). Haemorrhage and length of stay were not significantly associated with surgeon volume. CONCLUSION: The incidence of persistent hypercalcaemia, post-operative hypocalcaemia, and persistent hypoparathyroidism decreased with increasing surgeon volume. The relative reduction in persistent hypercalcaemia with surgeon volume was similar in image negative and positive groups, but the absolute reduction was higher in image negative cases. Restricting image negative parathyroidectomy to high-volume surgeons could be considered.

Improving undergraduate education in surgical paediatrics using near-peer assisted learning tutorials.

INTRODUCTION: Near-peer assisted learning (NPAL) has been welcomed in recent years as a favourable method for teaching medical students. It has proven advantages for both the educator and the learner. As such it was identified as an ideal approach for delivering the local curriculum within a paediatric surgical setting. Short duration of placements further suggests that structured tutorials would best guarantee coverage of the student curriculum. Our hypothesis was that the introduction of a structured programme such as this could lead to reduced dependence on senior staff for teaching, increased exposure of junior staff as educators, and increased coverage of the curriculum. METHODS: Curriculum outcomes were identified, and a series of tutorials developed for delivery by juniors within the department. Pre and post intervention questionnaires were given to students rotating through the department. RESULTS: 70 responses were analysed (23 pre; 47 post intervention). Reliance on Consultant teaching dropped 29% and engagement of surgical, GP and foundation trainees in teaching increased by 29%, 43% and 9% respectively. Overall curriculum coverage increased by 12%. CONCLUSION: A near-peer assisted tutorial programme is an effective way of increasing coverage of the medical curriculum with benefits for tutors and learners, whilst increasing junior engagement in teaching and reducing burden on Consultants.