Recent trends in thyroid surgery in Wales

Introduction: Our objective was to analyse trends in thyroid surgery in Wales over a recent 12-year period. Methods: Details of patients who underwent thyroid surgery across Wales from 1999 to 2010 were analysed from the Patient Episodes Database for Wales [. n=6570, 83% (5429) female, 86% (5634) benign thyroid disease]. We determined age-adjusted thyroidectomy rates from the European standard population and a Poisson regression model was fitted to assess temporal trends. Joinpoint regression was used to calculate annual percentage change (APC) in thyroidectomy rates. Results: An increase in thyroidectomy rates was observed for malignant disease [APC 4.5, 95% confidence interval (CI) 1.6-7.5] while surgery rates for benign disease declined over the period (APC -3.2, 95% CI -5.1 to -1.3). The use of total thyroidectomy rose from 17% (599/3501) in 1999-2004 to 30% (912/3069) in 2005-2010 (p<0.001). Total thyroidectomies were performed in a higher proportion of males than females [26% (291/1141) vs. 22% (1220/5429), p=0.03] and in a greater percentage of patients with malignant disease than benign [36% (337/936) vs. 21% (1174/5634), p<0.001). General surgeons undertook 83% of thyroid surgery but with a growing involvement of ENT surgeons. Regional disparities were seen in the type of surgery offered to patients with benign thyroid disease. Conclusion: The use of total thyroidectomy for benign and malignant thyroid disease has risen in Wales. The increase in surgeries performed for malignancy would support a rising incidence of thyroid cancer in the region. Regional disparities in choice of surgery for benign disease require further exploration.