American Association Of Endocrine Surgeons Research Articles

Trends in using intraoperative parathyroid hormone monitoring during parathyroidectomy: Protocol and rationale for a cross-sectional survey study of North American surgeons.

Hyperparathyroidism is a common endocrine disorder that occurs secondary to abnormal parathyroid gland functioning. Depending on the type of hyperparathyroidism, surgical extirpation of hyperfunctioning parathyroid glands can be considered for disease cure. Intraoperative parathyroid hormone (IOPTH) monitoring improves outcomes in patients undergoing surgery for primary hyperparathyroidism, but studies are needed to characterize its institutional adoption and its role in surgery for secondary and tertiary hyperparathyroidism, as these entities can be difficult to cure. Hence, we will perform a cross-sectional survey study of surgeon rationale, operational details, and barriers associated with IOPTH monitoring adoption across North America. We will utilize a convenience sampling technique to distribute an online survey to head and neck surgeons and endocrine surgeons across North America. This survey will be distributed via email to three North American professional societies (i.e., Canadian Society for Otolaryngologists-Head and Neck Surgeons, American Head and Neck Society, and American Association of Endocrine Surgeons). The survey will consist of 30 multiple choice questions that are divided into three concepts: (1) participant demographics and training details, (2) details of surgical adjuncts during parathyroidectomy, and (3) barriers to adoption of IOPTH. Descriptive analyses and multiple logistic regression will be used to evaluate the impact of demographic, institutional, and training variables on the use of IOPTH monitoring in surgery for all types of hyperparathyroidism and barriers to IOPTH monitoring adoption. Ethics approval was obtained by the Hamilton Integrated Research Ethics Board (2024-17173-GRA). These findings will characterize surgeon and institutional practices with regards to IOPTH monitoring during parathyroid surgery and will inform future trials aimed to optimize the use of IOPTH monitoring in secondary and tertiary hyperparathyroidism.

What constitutes quality in endocrine surgery? Statement from the American Association of Endocrine Surgeons

What constitutes quality in endocrine surgery? Statement from the American Association of Endocrine Surgeons

Quality appraisal of clinical practice guidelines for the evaluation and management of primary hyperparathyroidism

PurposeMultiple groups have created clinical practice guidelines (CPGs) for the management of primary hyperparathyroidism (PHPT). This report provides a rigorous quality assessment using the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II) to identify high-performing guidelines and areas for improvement.MethodsA systematic review was conducted to isolate CPGs addressing the management of PHPT. Guideline data was extracted and quality ratings were assigned by four independent reviewers. Intraclass correlation coefficients (ICC) were calculated to ensure interrater reliability.ResultsTwelve guidelines were assessed. The American Association of Endocrine Surgeons (AAES) guideline had the highest mean scaled score across all domains (73.6 ± 31.4%). No other published guideline achieved a “high” quality designation. The highest scoring domain was “clarity of presentation” (mean 60.5 ± 26.5%). The lowest scoring domain was “applicability” (mean 19.8 ± 18.2%). Scoring reliability was excellent, with ICC ≥ 0.89 for all AGREE II 6 domains.ConclusionAlthough several working groups have developed guidelines to address PHPT management, only those published by the AAES meet all methodologic quality criteria necessary to ensure incorporation of recommendations into clinical practice. Future guidelines would benefit from the development of tools, resources, monitoring criteria that enhance applicability.

Who Serves Where: A Geospatial Analysis of Access to Endocrine Surgeons in the United States and Puerto Rico

BackgroundThe association between surgical volume and patient outcome is well established, with higher case volume associated with a lower risk of complications. We hypothesized that the geographic distribution of endocrine/head and neck surgeons with an endocrine focus in the United States and Puerto Rico may limit access to many potential patients, particularly in rural areas. MethodsWe used web-based directories from the American Association of Endocrine Surgeons, American Head and Neck Society, and the American Academy of Otolaryngology–Head and Neck Surgery to identify endocrine surgery specialists in the United States and Puerto Rico. Using geographic coordinates and OpenStreetMap and Valhalla software, we calculated the areas within a 60-, 90-, or 120-minute driving distance from specialist offices. We used 2020 U.S. Census Data to calculate census tract populations inside or outside the accessible areas. ResultsExcluding duplicate providers across organizations, we geocoded 603 specialist addresses in the United States and Puerto. We found that 23.76% (78.3 million) of Americans do not have access to a society-affiliated endocrine/head and neck surgeon with an endocrine focus within a 60-minute drive, 14.37% (47.4 million) within a 90-minute drive, and 8.38% (27.6 million) within a 120-minute drive. We observed that the areas of coverage are primarily focused on metropolitan areas. ConclusionNearly one-third of Americans do not have access to a society-affiliated endocrine/head and neck surgeon with an endocrine focus within a 1-hour drive, highlighting a concerning geographic barrier to care. Further work is needed to facilitate patient access and mitigate disparities in quality care.

Advancing Preoperative Strategies for Thyroidectomy in Graves' Disease: A Narrative Review.

Graves' disease is an autoimmune disorder characterized by thyroid-stimulating antibodies that can potentially lead to thyrotoxicosis, goiter, skin disease, and eye disease. Available treatment options for Graves' disease include management with antithyroid drugs (ATDs), thyroid ablation with radioactive iodine (RAI), and surgical thyroid gland removal. For individuals unable to reach a normal thyroid hormone level, promptly considering a thyroidectomy is essential. Preoperative strategies to achieve a euthyroid state prevent thyroid storms and minimize postoperative complications and are therefore crucial. While variations in professional guidance exist, this review focuses on standard medical interventions as well as compares respective guidelines set forth by the American Thyroid Association, the European Thyroid Association, the American Association of Clinical Endocrinology, and the American Association of Endocrine Surgeons. There is consensus among these organizations underscoring the importance of rendering patients euthyroid prior to surgery and the use of ATDs. Most guidelines recommend screening for vitamin D deficiency as well as endorse thyroidectomy as the preferred treatment option for hyperthyroidism with skilled surgeons. Nevertheless, discrepancies do become apparent in aspects such as potassium iodide (SSKI) course duration and preoperative dexamethasone administration. By understanding these differing approaches, healthcare professionals can more effectively manage Graves' disease prior to surgery, resulting in improved patient outcomes and enhanced surgical success.

American Association of Endocrine Surgeons Meeting: Presidential Address

It has truly been a privilege to be your president over the last year and having the opportunity to help guide my favorite professional organization out of the COVID pandemic has been particularly humbling.

A historical look at Cleveland: Its health care institutions and contributions to endocrine surgery

It is a great honor to be able to give the Stuart D. Wilson, MD Historical Lecture. I wanted to thank Dr Fahey for giving me this opportunity for which I am deeply grateful. I first became a member of the American Association of Endocrine Surgeons (AAES) in 1992 and on my wall in my office is my membership certificate signed by the president of the AAES, who was Stuart D. Wilson, MD.

Gender Disparities in Academic Productivity and Promotion Among Endocrine Surgery Faculty

IntroductionAcademic rank and metrics such as total publications (pubs) and H-index are indicators to measure academic achievement. This study aims to determine whether there are gender differences in academic productivity or faculty appointments among endocrine surgeons in the United States. MethodsA database was generated from the American Association of Endocrine Surgeons (AAES) website. Community or academic practice was designated by institution affiliation and faculty appointment. Academic metrics, including pubs, H-index, and weighted-RCR (relative citation ratio), were obtained from public databases. ResultsA total of 258 AAES members were affiliated with an academic institution. The majority were men (58%). Overall, men in endocrine surgery had higher academic metrics: pubs (56.0 [26-134], 23.0 [11-56], P < 0.0001), H-index (19.0 [11-35], 9.0 [5-21], P < 0.0001), weighted-RCR (63.5 [22-193], 24.1 [8-74], P < 0.005) and rank (associate professor or professor, P < 0.0001). Subgroup analysis accounting for time in practice found no difference in total publications, weighted RCR, or faculty appointments between genders in practice for 0-5 y. However, among surgeons in practice for 6-10 y, men had higher academic metrics (pubs: 31.0 [16-79], 18.5 [9-33]; RCR: 46.0 [14-102], 13.3 [9-34]) and faculty appointments (all P < 0.05). ConclusionsThere are gender disparities in academic productivity and faculty appointment among US endocrine surgeons. While junior faculty show no gender differences in most indicators of academic productivity or rank, men with 6-10 y in practice have higher average academic metrics and rank. Whether the absence of gender disparities among junior faculty is a sustainable reflection of recent efforts to encourage equal mentorship and professional opportunities or whether disparities will manifest as faculty progress remains to be determined.

Abstract #1181964: Quality Assessment of Adrenal Incidentaloma Management at an Academic Community Hospital

Adrenal incidentalomas are nodules found in cross-sectional imaging studies intended for a different purpose. There are guidelines provided by the combined 2009 American Association of Clinical Endocrinology (AACE) and American Association of Endocrine Surgeons (AAES), and the 2020 Endocrine Society for evaluation and management of adrenal incidentalomas. We sought to assess compliance with these guidelines at an academic community hospital. Guidelines recommend a complete biochemical evaluation to identify functioning nodules. Non-functioning nodules >4 cm should be resected, while those less than 4 cm require radiographic reevaluation 3-24 months later and annually for 1 to 2 years. Our electronic medical record was queried for patients with adrenal incidentaloma between 1/2017-1/2018. Univariable and multivariable logistic regression analysis was used to identify factors associated with biochemical evaluation. 1776 patients were identified. Those with a history of malignancy and previously identified adrenal nodules were excluded, leaving 235 patients. Complete biochemical evaluation was minimal for patients of all ages (16.0%), despite radiological identity (adenoma or indeterminate). 2 cm nodules were more likely to get a complete biochemical evaluation vs nodules 1-2 cm (11.5% vs 4.1%, p-value =0.003). Patients 18-50 were more likely to have a complete biochemical evaluation than those between 51-80 and >80 (20.0% vs 5.4% vs 0%, p-value =0.006). All age groups had less than 40.0% recommended repeat imaging and less than 7.0% had repeat imaging. Nodules >2 cm were more likely to have imaging recommendations and 16 month repeat imaging vs 1-2 cm nodules (21.8% vs 6.8% vs p-value =0.007). Adenomas were more likely to have imaging recommendations and 16 month repeat imaging vs indeterminate nodules (16.7% vs 8.2%, p-value =0.039). Only 3 patients had nodules >4 cm and 1 patient had surgery (lap adrenalectomy). Clinicians and radiologists are not following guidelines for adrenal incidentalomas. Clinicians and radiologists should be educated on biochemical evaluation and repeat imaging so patients in need of surgical resection are not missed. Radiographic reports should include imaging and biochemical recommendations for adrenal incidentalomas.

The impact of patient age on practice patterns and outcomes for primary hyperparathyroidism

BackgroundManagement of asymptomatic primary hyperparathyroidism (PHPT) in older patients (age >50) is controversial. The 4th International Workshop on the Management of Asymptomatic PHPT recommends surveillance for older patients who lack objective signs of disease, whereas The American Association of Endocrine Surgeons (AAES) guidelines recommend consideration of parathyroidectomy for patients of any age with subjective constitutional, neuropsychiatric, or cognitive symptoms. Therefore, the primary objective of this study was to evaluate the association between patient age and both practice patterns and outcomes in the management of patients with sporadic PHPT. MethodsThe Collaborative Endocrine Surgery Quality Improvement Program (CESQIP) database was queried for all adults (age ≥18) who underwent an index parathyroidectomy for sporadic primary hyperparathyroidism between 2014 and 2020. Associations between patient age (≤50 years vs. >50 years) and both practice patterns and outcomes were evaluated separately using adjusted multivariable logistic and multinomial regression models. ResultsOf 9,938 patients who underwent parathyroidectomy, 8,080 (81.3%) were >50 years old and 1,858 (18.7%) were ≤50. Of this cohort, 17% of older patients and 26% of younger patients presented with only subjective symptoms. Compared to younger patients, older patients were more likely to have an objective indication for parathyroidectomy (aOR = 1.8, 95%CI: 1.6–2.0, p < 0.001). They were also more likely to undergo ≥2 imaging studies pre-operatively (aOR = 1.2, 95%CI: 1.1–1.3, p = 0.003), to undergo bilateral neck exploration (aOR = 1.4, 95%CI: 1.3–1.6, p < 0.001), and to have multi-gland disease (aOR = 1.6, 95%CI: 1.4–1.8, p < 0.001). There was no difference between age groups and parathyroidectomy-related complications including hypocalcemia, vocal cord dysfunction, hematoma requiring evacuation, or reintubation, however, older patients were less likely to have any peri-operative morbidity (aOR = 0.7, 95%CI: 0.6–0.9, p = 0.011). ConclusionsOlder patients were more likely to meet objective criteria prior to undergoing parathyroidectomy by CESQIP participating high-volume endocrine surgeons, however they were less likely to have peri-operative complications compared to younger patients. Given the growing evidence demonstrating improvement of both objective and subjective symptoms after parathyroidectomy for PHPT, additional studies are still needed to fully understand the benefit of surgical referral in older adults for less objective indications.

Intraoperative assessment of parathyroid pathology in sporadic primary hyperparathyroidism: an institutional experience

Intraoperative consultation for assessment of parathyroid tissue is a controversial area of endocrine pathology. This assessment often follows historical institutional and individual surgical practitioner practices rather than documented utility data and adjuvant intraoperative testing data, including intraoperative parathyroid hormone level testing by clinical pathologists and the use of Oil Red O vital stain on frozen tissue sections by anatomic pathologists, as a means of conferring etiology of parathyroid disease. The American Association of Endocrine Surgeons (AAES), in 2016, proposed guidelines for the management of primary hyperparathyroidism, including recommendations for intraoperative consultation, recommending against the use of intraoperative frozen section to determine parathyroid functional status but in support for its use for parathyroid identification. In this series, we review a one-year, retrospective cohort of consecutive parathyroid surgeries at Massachusetts General Hospital, including over 200 cases meeting inclusion criteria for which primary hyperparathyroidism was the indication for surgery, discussing outcomes, compliance with AAES guidelines, and overall utility of intraoperative consultation and adjuvant testing.

Endocrine surgeons have high rates of work-related musculoskeletal (MSK) injury and symptoms

BackgroundWork-related injury and musculoskeletal (MSK) symptoms are common among surgeons, however data for endocrine surgeons (ES) are lacking. MethodsA survey was distributed to American Association of Endocrine Surgeons (AAES) and Endocrine section of American Head and Neck Society (AHNS) members. ResultsMSK symptoms were present in 199 (90%) of 220 respondents, most notably pain (91%) and stiffness (81%). The most common locations were neck (87%) and shoulders (55%). Women were more likely to be symptomatic (98.6% versus 86.4%, p = 0.004). Although 67% of respondents reported awareness of ergonomic principles, only 19% had learned about them during training. The most common ergonomic adjustments were stretching, use of microbreaks and headlight/loupe adjustments. ConclusionThe vast majority of ES surgeons suffer MSK symptoms that could potentially impact their quality of life and career length. Effective strategies are needed to protect this highly trained workforce.

Dr. Janice L. Pasieka receives the Oliver Cope Meritorious Achievement Award of the American Association of Endocrine Surgeons

Dr. Janice L. Pasieka receives the Oliver Cope Meritorious Achievement Award of the American Association of Endocrine Surgeons

The glass podium: Gender representation within the American Association of Endocrine Surgeons (AAES) from 2010 to 2019

BackgroundDespite increasing numbers of women in surgery, female underrepresentation in surgical societies remains an ongoing issue. We sought to determine the gender composition of presenters at the American Association of Endocrine Surgery annual meetings. MethodsUtilizing previous meeting data, we collected gender information for presenters from 2010 to 2019, including first/senior author combinations. Awards winners and invited lecturers were also reviewed. We performed binomial testing to analyze proportions of male to female presenters, with significance set at P < .05. Temporal trends were analyzed via linear regression. ResultsFifty-six percent of American Association of Endocrine Surgery fellows and 36% of members are female. Of 354 podium and 477 poster presentations, women were listed less often as first (42.7%, P = .007) and senior (30.6%, P < .0001) podium authors and less often as first (42.8%, P = .002) and senior (29.8%, P < .0001) poster authors. The most common combination of first/senior authors was male–male (43.1%), followed by female–male (26.8%), female–female (16.1%), and male–female (14.0%). Less than 15% of invited lecturers were women, and women represented a minority in nearly all award categories. We observed a positive trend in female first authorship over time (slope = 0.766, 95% confidence interval, 0.70%−2.23%, P = .26) but no change in female senior authorship over time (slope = 0.03348, 95% confidence interval, 1.086%−1.153%, P = .95). ConclusionWomen are underrepresented as American Association of Endocrine Surgery presenters and less likely to receive awards or deliver invited lectures. Although female first authorship increased over time, women continued to lag behind men as senior authors and mentors to trainees and junior faculty. Opportunities to improve speaker and awardee representation should be explored.

Professional Internet Presence Amongst Endocrine Surgeons in the United States

There is a wide range of social media adoption within medical specialties. The use of social media by endocrine surgeons has not been investigated. We undertook this study to describe the use of social media and other platforms by endocrine surgeons. The American Association of Endocrine Surgeons' publicly available website was used to identify practicing endocrine surgeons in the United States. Surgeon demographics and practice characteristics were collected via internet query. Five social media platforms (Facebook, Instagram, Twitter, LinkedIn, YouTube) were investigated for professional accounts. The presence of a non-institutional professional website, an active Healthgrades account, and presence in non-institutional YouTube videos were also queried. One point was assigned for presence on each of the eight platforms. A professional internet presence (PIP) score was calculated. Descriptive statistics were performed on PIP scores to evaluate the relationship between surgeon and practice characteristics and PIP score. A total of 417 endocrine surgeons were studied. LinkedIn (222, 53.2%) and Twitter (110, 26.4%) were the most commonly used platforms. PIP scores were categorized into zero, one, two, and three or more accounts; 26.9% of surgeons had no professional internet presence. Academic surgeons had a significantly different PIP score than community-based surgeons (P < 0.01). There was no significant association between PIP score and surgeon sex, geographic regions, rural versus urban settings, and years of experience. Self-identified US endocrine surgeons have low professional internet presence. Endocrine surgeons may consider bolstering their professional internet presence to disseminate medical information.

Impact of the COVID-19 pandemic on the practice of endocrine surgery

BackgroundThis study investigates the impact of the COVID-19 pandemic on endocrine surgeons. MethodsA survey on the professional, educational, and clinical impact was sent to active and corresponding members of the American Association of Endocrine Surgeons (AAES) in September 2020. Chi-square and paired t-test were used for analysis. Results77 surgeons responded (14.8 %). All reported suspension of elective surgeries; 37.7 % were reassigned to other duties during this time. The median number of cases backlogged was 30 (IQR 15–50). Most surgeons reported decreased clinical volume (74.6 %). The use of virtual platforms for clinical and educational purposes increased from pre-COVID-19 levels (all p < 0.001). Use of in-office procedures (p < 0.001) and length of observation prior to discharge for thyroid surgery (p < 0.05) decreased. ConclusionThe COVID-19 pandemic led to suspension of operations and decreased practice volume for endocrine surgeons. Surgeons increased use of virtual platforms, decreased in-office procedures, and decreased duration of observation for thyroid surgery in response.

Molecular Testing for Thyroid Nodules Including Its Interpretation and Use in Clinical Practice.

Despite advances in imaging and biopsy techniques, the management of thyroid nodules often remains a diagnostic and clinical challenge. In particular, patients with cytologically indeterminate nodules often undergo diagnostic thyroidectomy although only a minority of patients are found to have thyroid malignancy on final pathology. More recently, several molecular testing platforms have been developed to improve the stratification of cancer risk for patients with cytologically indeterminate thyroid nodules. Based on numerous studies demonstrating its accuracy, molecular testing has been incorporated as an important diagnostic adjunct in the management of indeterminate thyroid nodules in the National Comprehensive Cancer Network Guidelines as well as in the American Thyroid Association (ATA) and American Association of Endocrine Surgeons (AAES) guidelines. This overview describes the currently available molecular testing platforms and highlights the published data to date on the clinical validity and utility of molecular testing in the contemporary management of thyroid nodules.

Endocrine surgery is at the forefront of gender diversity

BackgroundThe purpose of this study is to assess gender diversity across surgical subspecialties, with a focus on endocrine surgery. MethodsWe collected publicly-reported data from Association of American Medical Colleges (AAMC) and American Association of Endocrine Surgeons (AAES) during the 2017 data period. Student’s t-test and Analysis of Variance (ANOVA) were used to compare percentages of female surgeons. We analyzed data by geographical regions, excluding states where data was unreported/unavailable. ResultsDuring this period, there were 25,022 general surgeons. Of these, 5157 (20.6%) were female. There were 513 endocrine surgeons, of which 179 (34.8%) were female (p < 0.001). Across the US, endocrine surgery had the greatest percentage of female surgeons (34.8%) compared to other surgical subspecialties (p < 0.001). When comparing geographical regions, the Northeast (22.8%) and West (22.8%) contained the highest percentages of female general surgeons, while the South comprised the greatest proportion of female endocrine surgeons (38.7%). ConclusionsEndocrine surgery has the most gender diversity of all studied surgical subspecialties. The Southern US has the greatest proportion of female endocrine surgeons.

Understanding surgical decision-making in older adults with differentiated thyroid cancer: A discrete choice experiment

BackgroundPrior studies demonstrated that older adults tend to undergo less surgery for thyroid cancer. Our objective was to use a discrete choice experiment to identify factors influencing surgical decision-making for older adults with thyroid cancer. MethodsActive and candidate members of the American Association of Endocrine Surgeons were invited to participate in a web-based survey. Multinomial logistic regression was utilized to assess patient and surgeon factors associated with treatment choices. ResultsComplete survey response rate was 25.7%. Most respondents were high-volume surgeons (88.5%) at academic centers (76.9%). Multinomial logistic regression demonstrated that patient age was the strongest predictor of management. Increasing age and comorbidities were associated with the choice for active surveillance (P = .000), not performing a lymphadenectomy in patients with nodal metastases (relative-risk ratio: 2.5, 95% CI: 1.4–4.2, P = .002 and relative-risk ratio: 1.6, 95% CI: 1.2–2.1, P = .004, respectively), and recommending hemithyroidectomy versus total thyroidectomy for a cancer >4 cm (relative-risk ratio: 4.4, 95% CI: 2.5–7.9, P = .000 and relative-risk ratio: 3.4, 95% CI: 2.3–5.1, P = .000, respectively). Surgeons with ≥10 years of experience (relative-risk ratio: 3.3, 95% CI: 1.1–10.3, P = .039) favored total thyroidectomy for a cancer <4 cm, and nonfellowship trained surgeons (relative-risk ratio: 7.3, 95% CI: 1.3–42.2, P = .027) opted for thyroidectomy without lymphadenectomy for lateral neck nodal metastases. ConclusionThis study highlights the variation in surgical management of older adults with thyroid cancer and demonstrates the influence of patient age, comorbidities, surgeon experience, and fellowship training on management of this population.

Ethical framework for head and neck endocrine surgery in the COVID-19 pandemic.

Ethical framework for head and neck endocrine surgery in the COVID-19 pandemic.