scholarly journals The Volume-Outcome Relationship in Retroperitoneal Soft Tissue Sarcoma: Evidence of Improved Short- and Long-Term Outcomes at High-Volume Institutions

Sarcoma ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Sanjay P. Bagaria ◽  
Matthew Neville ◽  
Richard J. Gray ◽  
Emmanuel Gabriel ◽  
Jonathan B. Ashman ◽  
...  
Keyword(s):  
Overall Survival ◽  
Care Delivery ◽  
National Level ◽  
Survival Rates ◽  
High Volume ◽  
Surgical Mortality ◽  
Case Volume ◽  
Outcome Relationship ◽  
Low Volume

Background. We sought to study the association between RPS case volume and outcomes. Although a relationship has been demonstrated between case volume and patient outcomes in some cancers, such a relationship has not been established for retroperitoneal sarcomas (RPSs). Study Design. The National Cancer Database (NCDB) was queried for patients undergoing treatment for primary RPS diagnosed between 2004 and 2013. Mean annual patient volume for RPS resection was calculated for all hospitals and divided into low volume (<5 cases/year), medium volume (5–10 cases/year), and high volume (>10 cases/year). Risk-adjusted regression analyses were performed to identify predictors of 30-day surgical mortality, R0 margin status, and overall survival (OS). Results. Our study population consisted of 5,407 patients with a median age of 61 years, of whom 47% were male and 3,803 (70%) underwent surgical resection. Absolute 30-day surgical mortality and R0 margin rate following surgery for low-, medium-, and high-volume institutions were 2.4%, 1.3%, and 0.5% (p=0.027) and 68%, 65%, and 82%, (p<0.001), respectively. Five-year overall survival rates for low, medium, and high-volume institutions were 56%, 57%, and 66%, respectively (p<0.001). Patients treated at low-volume institutions had a significantly higher risk of 30-day mortality (adjusted OR = 4.66, 95% CI 2.26–9.63) and long-term mortality (adjusted HR = 1.56, 95% CI 1.16–2.11) compared to high-volume institutions. Conclusion. We demonstrate the existence of a hospital sarcoma service line volume-oncologic outcome relationship for RPS at the national level and provide benchmark data for cancer care delivery systems and policy makers.

scholarly journals Mortality and Survival Rates after Elective Hepatic Surgery in a Low-Volume Centre Are Comparable to Those of High-Volume Centres

ISRN Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
I. E. Nygård ◽  
K. Lassen ◽  
J. Kjæve ◽  
A. Revhaug
Keyword(s):  
Overall Survival ◽  
Liver Resection ◽  
Survival Rates ◽  
Disease Free Survival ◽  
High Volume ◽  
Colorectal Metastases ◽  
Rank Test ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Low Volume

Background. Over the last decades, liver resection has become a frequently performed procedure in western countries because of its acceptance as the most effective treatment for patients with selected cases of metastatic tumours. The purpose of this study was to evaluate the results after hepatic resections performed electively in our centre since 1979 and compare the results to those of larger high-volume centres. Methods. Medical records of all patients who underwent liver resection from January 1979 to December 2011 were reviewed. Disease-free survival and overall survival were determined by Kaplan-Meier analysis. Risk factors for complications were tested with the log-rank test and the Cox proportional hazard model. Complications were classified according to the modified Clavien classification system. Results. 290 elective liver resections were performed between January 1979 and December 2011. There were 171 males (59.0%) and 119 females (41.0%). Median age was 63 years, range 1–87. Overall survival ranged from 0 to 383 months, with a median of 31 months. Five-year survival rate for patients who underwent liver resection for colorectal metastases was 35.8% (34/95). Discussion. Hepatic resections are safely performed at a low-volume centre, with regard to perioperative- and in-house mortality and 5-year survival rates.

Hospital Volume, Margin Status, and Long-Term Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

2012 ◽  
Vol 78 (2) ◽  
pp. 225-229 ◽  
Author(s):  
Marco La Torre ◽  
Giuseppe Nigri ◽  
Linda Ferrari ◽  
Giulia Cosenza ◽  
Matteo Ravaioli ◽  
...  
Keyword(s):  
Pancreatic Surgery ◽  
Hospital Volume ◽  
Survival Rates ◽  
High Volume ◽  
Margin Status ◽  
Negative Margin ◽  
Term Survival ◽  
Modeling And Analysis ◽  
Low Volume

An association between hospital surgical volume and short- and long-term outcomes after pancreatic surgery has been demonstrated. Identification of specific factors contributing to this relationship is difficult. In this study, the authors evaluated if margin status can be identified as a measure of surgical quality, affecting overall survival, as a function of hospital pancreaticoduodenectomy volume. A systematic review of the literature was performed. Two models for analysis were created, dividing the 18 studies identified into quartiles and two quantiles based on the average annual hospital pancreatectomy volume. Regression modeling and analysis of variance were used to find an association between hospital volume, margin status, and survival. Increasing hospital volume was associated with a significantly increased negative margin status rate: 55 per cent for low-volume, 72 per cent for medium-volume, 74.3 per cent for high-volume, and 75.7 per cent for very high-volume centers ( P = 0.008). The negative margin status rates were 64 per cent and 75.1 per cent for volume centers with less and more than 12 pancreaticoduodenectomies/year, respectively ( P = 0.04). Low-volume centers negatively affected both margin positive resection and 5-year survival rates, compared with high-volume centers. Margin status rate after pancreaticoduodenectomy could, therefore, be considered a measure of quality for selection of hospitals dedicated to pancreatic surgery.

scholarly journals Association between hospital liver transplantation volume and mortality after liver re-transplantation

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255655
Author(s):  
Seung-Young Oh ◽  
Eun Jin Jang ◽  
Ga Hee Kim ◽  
Hannah Lee ◽  
Nam-Joon Yi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hospital Mortality ◽  
High Volume ◽  
Case Volume ◽  
Term Survival ◽  
Healthcare Insurance ◽  
Comorbidity Index ◽  
Low Volume ◽  
The Relationship

Background The relationship between institutional liver transplantation (LT) case volume and clinical outcomes after liver re-transplantation is yet to be determined. Methods Patients who underwent liver re-transplantation between 2007 and 2016 were selected from the Korean National Healthcare Insurance Service database. Liver transplant centers were categorized to either high-volume centers (≥ 64 LTs/year) or low-volume centers (< 64 LTs/year) according to the annual LT case volume. In-hospital and long-term mortality after liver re-transplantation were compared. Results A total of 258 liver re-transplantations were performed during the study period: 175 liver re-transplantations were performed in 3 high-volume centers and 83 were performed in 21 low-volume centers. In-hospital mortality after liver re-transplantation in high and low-volume centers were 25% and 36% (P = 0.069), respectively. Adjusted in-hospital mortality was not different between low and high-volume centers. Adjusted 1-year mortality was significantly higher in low-volume centers (OR 2.14, 95% CI 1.05–4.37, P = 0.037) compared to high-volume centers. Long-term survival for up to 9 years was also superior in high-volume centers (P = 0.005). Other risk factors of in-hospital mortality and 1-year mortality included female sex and higher Elixhauser comorbidity index. Conclusion Centers with higher case volume (≥ 64 LTs/year) showed lower in-hospital and overall mortality after liver re-transplantation compared to low-volume centers.

scholarly journals A New Aortic Arch Dissection Classification: The Fuwai Classification

2021 ◽  
Vol 8 ◽  
Author(s):  
Juntao Qiu ◽  
Xinjin Luo ◽  
Jinlin Wu ◽  
Wei Pan ◽  
Qian Chang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Aortic Arch ◽  
Survival Rates ◽  
Innominate Artery ◽  
Long Term Results ◽  
Surgical Mortality ◽  
Left Carotid Artery ◽  
Term Survival ◽  
Long Term Survival

Aims: We describe a new aortic arch dissection (AcD) classification, which we have called the Fuwai classification. We then compare the clinical characteristics and long-term prognoses of different classifications.Methods: All AcD patients who underwent surgical procedures at Fuwai Hospital from 2010 to 2015 were included in the study. AcD procedures are divided into three types: Fuwai type Cp, Ct, and Cd. Type Cp is defined as the innominate artery or combined with the left carotid artery involved. Type Cd is defined as the left subclavian artery or combined with the left carotid artery involved. All other AcD surgeries are defined as type Ct. The Chi-square test was adopted for the pairwise comparison among the three types. Kaplan-Meier was used for the analysis of long-term survival and survival free of reoperation.Results: In total, 1,063 AcD patients were enrolled from 2010 to 2015: 54 patients were type Cp, 832 were type Ct, and 177 were type Cd. The highest operation proportion of Cp, Ct and Cd were partial arch replacement, total arch replacement, and TEVAR. The surgical mortality in type Ct was higher compared to type Cd (Ct vs. Cd = 9.38 vs. 1.69%, p &lt; 0.01) and type Cp (Ct vs. Cp = 9.38 vs. 1.85%, p = 0.06). There was no difference in surgical mortality of type Cp and Cd (p = 0.93). There were no significant differences in the long-term survival rates (p = 0.38) and free of aorta-related re-operations (p = 0.19).Conclusion: The Fuwai classification is used to distinguish different AcDs. Different AcDs have different surgical mortality and use different operation methods, but they have similar long-term results.

scholarly journals Association between Transplant Volumes and 30-Day Readmissions Following Allogeneic Hematopoietic Cell Transplantation (allo-HCT) in the US

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 617-617
Author(s):  
Binod Dhakal ◽  
Smith Giri ◽  
Adam Levin ◽  
Rein Lisa ◽  
Timothy S. Fenske ◽  
...  
Keyword(s):  
Research Funding ◽  
High Volume ◽  
Medicare Beneficiaries ◽  
Case Volume ◽  
Readmission Rates ◽  
Stem Cell Source ◽  
Co Morbidity ◽  
Equity Ownership ◽  
Low Volume ◽  
Morbidity Index

Abstract Background: Readmissions within 30 days after index hospitalization is a quality and cost-containment metric. Financial penalties to hospitals with high rates of risk-adjusted readmissions have been expanded beyond medical conditions like heart failure and pneumonia. Published data show significant heterogeneity in readmission rates and recent data from elderly Medicare beneficiaries reported a 17.8% readmission rate for targeted conditions. Allo-HCT is a widely used therapeutic strategy in the management of various hematologic disorders like acute myelogenous (AML) and lymphoblastic leukemia (ALL). However, allo-HCT readmission rates are poorly described, and limited to single center studies only. The association between institution HCT volume and 30-day readmission metric has not been examined. Methods: In this observational study, we used the 2012-2014 Nationwide Readmission Database (NRD) to identify hospitals with established allo-HCT programs. Patients ≥18 years of age, discharged from hospital following an allo-HCT (identified using ICD-9 procedure code of 41.02, 41.03, 41.05, 41.06, or 41.08) were included. Annual hospital case volume was calculated as the sum of all discharges with allo-HCT within the calendar year; low, medium, and high annual case volume groups were created based on (survey weighted) tertiles of patients (pts.) in the analytic data domain (Figure 1). Rates, causes, and costs of 30-day readmissions were compared between low-, medium-, and high-volume hospitals. The analysis was limited to urban teaching hospitals and pts. admitted during month of December were excluded. The primary outcome, was the unplanned 30-day re-admission following allo-HCT. Multiple logistic regression was used to model each 30-day readmission outcome including hospital case volume with other predictors (age, sex, disease type, stem cell source, co-morbidity index, primary insurance, length of stay, infection and acute graft-versus-host-disease (aGVHD) at index admission, discharge disposition and median income quartile). Results: A total of 17,214 (weighted) allo-HCTs were performed during the time period. Baseline characteristics of pts. in low (<58 allo-HCTs/yr.)-, medium (58-158 allo-HCTs/yr.)- and high-volume (>158 allo-HCTs/yr.) hospitals were comparable as shown in Table 1. The overall rates of readmissions were significantly higher in low volume centers (24.7.4%; SE, 1.5) compared to medium (21.4% (1.7) and high volume (9.5% (1.8), centers (p=0.03). The mean time to readmission in low vs. medium vs. high volume centers was, 11.6 [0.39] days vs. 12 [0.26] days vs. 11.5 [0.57] days respectively, (p <0.001). The length of readmission stay was significantly longer in low volume centers (mean [SD], 12.8 [0.64] days vs. 12.3 [0.91] days vs. 10.6 [0.80] days; p=<0.001) respectively. Consequently, cost per readmission was significantly higher in low volume centers (mean [SD], $164,349 [12,328] vs. $140,327 [15,297] vs. $107,362 [11,665]; p<0.001). Readmission rates in low volume and medium volume centers compared to high volume centers were: adjusted odds ratio (aOR) 1.39, 95% CI 1.08-1.77; p =0.01 and 1.18, 95% CI, 0.89-1.55; p=0.23, respectively. Other significant predictors of readmission included disease type (ALL vs. AML): aOR 1.32, 95% CI 1.07-1.63; p= 0.009), type of primary insurance (Medicare vs. private): aOR 1.17, 95% CI 1.01-1.35; p=0.02; Elixhauser co-morbidity index (≥1 vs. 0): aOR 1.4, 95% CI 1.2-1.7; p= 0.001 and stem cell source (cord blood vs. peripheral blood; aOR 2.4, 95%CI 1.85-3.2, p<0.001). Patients with any infection and the presence of aGVHD at index admission did not have an effect on readmission rates. Neutropenia, fever, viral infection, sepsis, acute renal failure, and pneumonia were the most common reasons for readmission. Conclusions: The likelihood of readmission after allo-HCT is elevated in centers performing <58 allo-HCTs/year, in those pts. with ≥1 co-morbidities, cord blood transplants, in ALL pts. and in Medicare beneficiaries. Lower readmission at higher-volume centers was associated with significantly lower cost to the health care system. There are important limitations with the use of data from NRD particularly the lack of information on donor status and conditioning regimen. Despite these shortcomings, the information may aid health care when developing quality-of-care metric for allo-HCT. Disclosures Dhakal: Amgen: Honoraria; Takeda: Honoraria; Celgene: Consultancy, Honoraria. Shah:Geron: Equity Ownership; Lentigen Technology: Research Funding; Juno Pharmaceuticals: Honoraria; Oncosec: Equity Ownership; Miltenyi: Other: Travel funding, Research Funding; Exelexis: Equity Ownership. D'Souza:Prothena: Consultancy, Research Funding; Takeda: Research Funding; Celgene: Research Funding; Merck: Research Funding; Amgen: Research Funding. Hari:Celgene: Consultancy, Honoraria, Research Funding; Janssen: Honoraria; Bristol-Myers Squibb: Consultancy, Research Funding; Kite Pharma: Consultancy, Honoraria; Sanofi: Honoraria, Research Funding; Amgen Inc.: Research Funding; Takeda: Consultancy, Honoraria, Research Funding; Spectrum: Consultancy, Research Funding. Hamadani:Sanofi Genzyme: Research Funding, Speakers Bureau; MedImmune: Consultancy, Research Funding; Celgene Corporation: Consultancy; Takeda: Research Funding; Cellerant: Consultancy; ADC Therapeutics: Research Funding; Ostuka: Research Funding; Janssen: Consultancy; Merck: Research Funding.

Is Outcome after Blunt Splenic Injury in Adults Better in High-Volume Trauma Centers?

2005 ◽  
Vol 71 (11) ◽  
pp. 942-949 ◽  
Author(s):  
Brian G. Harbrecht ◽  
Mazen S. Zenati ◽  
Louis H. Alarcon ◽  
Juan B. Ochoa ◽  
Juan C. Puyana ◽  
...  
Keyword(s):  
Emergency Department ◽  
Trauma Center ◽  
Injury Severity ◽  
Trauma System ◽  
High Volume ◽  
Trauma Centers ◽  
Case Volume ◽  
Center Volume ◽  
Low Volume ◽  
Outcome Differences

An association between outcome and case volume has been demonstrated for selected complex operations. The relationship between trauma center volume and patient outcome has also been examined, but no clear consensus has been established. The American College of Surgeons (ACS) has published recommendations on optimal trauma center volume for level 1 designation. We examined whether this volume criteria was associated with outcome differences for the treatment of adult blunt splenic injuries. Using a state trauma database, ACS criteria were used to stratify trauma centers into high-volume centers (>240 patients with Injury Severity Score >15 per year) or low-volume centers, and outcome was evaluated. There were 1,829 patients treated at high-volume centers and 1,040 patients treated at low-volume centers. There was no difference in age, gender, emergency department pulse, emergency department systolic blood pressure, or overall mortality between high- and low-volume centers. Patients at low-volume centers were more likely to be treated operatively, but the overall success rate of nonoperative management between high-and low-volume centers was similar. These data suggest that ACS criteria for trauma centers level designation are not associated with differences in outcome in the treatment of adult blunt splenic injuries in this regional trauma system.

scholarly journals Impact of case volume per year on flexible Ureteroscopy practice: an internet based survey

BMC Urology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Omar Alhunaidi ◽  
Abdulrahman A. Ahmad ◽  
Ahmed R. EL-Nahas ◽  
Bader Akroof ◽  
Ali Alamiri ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Group Versus ◽  
High Volume ◽  
Internet Survey ◽  
Flexible Ureteroscopy ◽  
Ureteral Stones ◽  
Case Volume ◽  
Ureteral Access Sheath ◽  
Volume Group ◽  
Low Volume

Abstract Background To report current worldwide variation in techniques and clinical practice of flexible ureteroscopy (FURS) among endourologists of different case volumes per year. Methods Two invitations to complete an internet survey were emailed to Endourological Society members. Some of survey questions asked about indications of using FURS for renal and upper ureteral stones. Others were concerned with clinical practice of FURS (such as preoperative stenting, use of ureteral access sheath (UAS) and safety guidewire, technique of Laser lithotripsy and fragment retrieval, and post-FURS stenting. Responders were distributed into two groups; high-volume (> 100 cases/year) and low-volume surgeons (< 100 cases/year) and data were compared between both groups. Results Responses were received from 146 endourologists all over the world (62 high-volume and 84 low-volume). FURS for intrarenal stone > 20 mm was used by 61% of high-volume surgeons compared with 28.6% for low-volume (P < 0.001). Semirigid URS was used for upper ureteric stones in 68% among high-volume group and 82% in low-volume group (P = 0.044). UAS was used by 62% in low-volume group and 69% in high volume group (P = 0.516). Laser stone dusting was preferred by 63% in low-volume group versus 45% by high-volume (P = 0.031). More responders in low-volume group preferred to leave the stent for 6 weeks (P = 0.042). Conclusions The use of FURS for treating upper tract calculi has expanded by high volume endourologists to include large renal stones > 20 mm. Low-volume surgeons prefer to use semi-rigid URS for treatment of upper ureteral stones, to apply Laser stone dusting and maintain ureteral stents for longer periods.

scholarly journals Comparison of prognosis between emergency and scheduled hemodialysis

2019 ◽  
Vol 47 (3) ◽  
pp. 1221-1231 ◽  
Author(s):  
Zhixiang Bian ◽  
Huiyi Gu ◽  
Peihua Chen ◽  
Shijian Zhu
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
Mortality Rate ◽  
Serum Creatinine ◽  
Survival Rates ◽  
Overall Survival Rate ◽  
Short Term ◽  
Term Survival ◽  
Renal Replacement Therapies

Background The survival rate of patients undergoing hemodialysis and other renal replacement therapies has been extensively studied, but comparative studies of emergency and scheduled hemodialysis are limited. Methods This study included 312 patients who underwent emergency hemodialysis and 274 who received scheduled hemodialysis. We investigated the prognostic differences between these two groups of patients, including the short-term and long-term survival rates. Results The overall survival rate was significantly better among the patients in the scheduled hemodialysis group than emergency hemodialysis group. The mortality rate within 3 months of emergency hemodialysis was 4.8%, while that within 3 months of scheduled hemodialysis was 1.1%. Conclusions Significant differences were present between emergency and scheduled hemodialysis, especially the levels of serum creatinine and hemoglobin.

A literature review of the role of brachytherapy in the management of early-stage breast cancer

2019 ◽  
Vol 19 (3) ◽  
pp. 281-290
Author(s):  
Rebecca Thorpe ◽  
Heather Drury-Smith
Keyword(s):  
Quality Of Life ◽  
Overall Survival ◽  
Local Recurrence ◽  
Literature Review ◽  
Survival Rates ◽  
External Beam Radiation ◽  
Recurrence Rates ◽  
Overall Survival Rates

AbstractBackground:This review evaluates whether brachytherapy can be considered as an alternative to whole breast irradiation (WBI) using criteria such as local recurrence rates, overall survival rates and quality of life (QoL) factors. This is an important issue because of a decline in local recurrence rates, suggesting that some women at very low risk of recurrence may be incurring the negative long-term side effects of WBI without benefitting from a reduction in local recurrence and greater overall survival. As such, the purpose of this literature review is to evaluate whether brachytherapy is a credible alternative to external beam radiation with a particular focus on the impact it has on patient QoL.Methods:The search terms used were devised by using the Population Intervention Comparison Outcome framework, and a literature search was carried out using Boolean connectors and Medical Subject Headings in the PubMed database. The resultant articles were manually assessed for relevance and appraised using the Scottish Intercollegiate Guidelines Network tool. Additional papers were sourced from the citations of articles found using the search strategy. Government guidelines and regulations were also used following a manual search on the National Institute for Health and Care Excellence website. This process resulted in a total of 30 sources being included as part of the review.Results:Three types of brachytherapy were the foundation for the majority of the papers found: interstitial multi-catheter brachytherapy, intra-cavity brachytherapy and permanent seed implantation. The key themes that arose from the literature were that brachytherapy is equivalent to WBI both in terms of 5-year local recurrence rates and overall survival rates at 10–12 years. The findings showed that brachytherapy was superior to WBI for some QoL factors such as being less time-consuming and equal in terms of others such as breast cosmesis. The results did also show that brachytherapy does come with its own local toxicities that could impact upon QoL such as the poor breast cosmesis associated with some brachytherapy techniques.Conclusion:In conclusion, brachytherapy was deemed a safe or acceptable alternative to WBI, but there is a need for further research on the long-term local recurrence rates, survival rates and quality of life issues as the volume of evidence is still significantly smaller for brachytherapy than for WBI. Specifically, there needs to be further investigation as to which patients will benefit from being offered brachytherapy and the influence that factors such as co-morbidities, performance status and patient choice play in these decisions.

Outcomes analysis of radioactive iodine and total thyroidectomy for pediatric Graves’ disease

2016 ◽  
Vol 29 (3) ◽  
Author(s):  
Reuven Zev Cohen ◽  
Eric I. Felner ◽  
Kurt F. Heiss ◽  
J. Bradley Wyly ◽  
Andrew B. Muir
Keyword(s):  
Children And Adolescents ◽  
Total Thyroidectomy ◽  
Relapse Rate ◽  
Radioactive Iodine ◽  
High Volume ◽  
Graves Disease ◽  
Complication Rates ◽  
Case Volume ◽  
Definitive Therapy

AbstractThe majority of pediatric patients with Graves’ disease will ultimately require definitive therapy in the form of radioactive iodine (RAI) ablation or thyroidectomy. There are few studies that directly compare the efficacy and complication rates between RAI and thyroidectomy. We compared the relapse rate as well as the acute and long-term complications of RAI and total thyroidectomy among children and adolescents with Graves’ disease treated at our center.Medical records from 81 children and adolescents with a diagnosis of Graves’ disease who received definitive therapy over a 12-year period were reviewed.Fifty one patients received RAI and 30 patients underwent thyroidectomy. The relapse rate was not significantly different between RAI and thyroidectomy (12.1% vs. 0.0%, p=0.28). There were no acute or long-term complications in the RAI group, but there were eight cases of hypoparathyroidism (two transient and six permanent) in the thyroidectomy group. None of the patients developed a recurrent laryngeal nerve injury.RAI is a safe and effective option for treatment of children and adolescents with Graves’ disease. In light of the rate of permanent hypoparathyroidism seen at our center with thyroidectomy and previously published long-term safety of RAI, we recommend RAI as the first line treatment for children and adolescents with Graves’ disease. For those centers performing thyroidectomies, we recommend that each center select 1–2 high-volume pediatric surgeons to perform all thyroid procedures, allowing individuals to increases case volume and potentially decrease long-term complications of thyroidectomy.

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