Is thyroid surgery performed too often in Germany?

Summary

Thyroid surgery is one of the more common surgical procedures in Germany. This is in contrast with the situation in some other countries, where this procedure is performed comparatively rarely. In this paper the number of thyroid surgeries in Germany is compared with other western countries (Netherlands, USA, England). In contrast to e. g. the USA and England the number of thyroid surgeries in Germany is declining, however with approximately 109/100 000/year in 2012 is still elevated (Netherlands: 16/100 000/year, USA: at least 42/100 000/year, England: at least 27/100 000/year).

Possible contributing factors to this higher number of thyroid surgeries in Germany are explored. These factors include iodine deficiency, the frequent use of advanced diagnostics such as ultrasound, insufficient use of preoperative diagnostic measures such as fine needle biopsy and the practice of “defensive medicine”. How much each of these factors contributes is however unclear.

Zusammenfassung

In Gegensatz zu anderen Ländern, wo die Prozedur relativ selten erfolgt, zählen Schilddrüsenoperation zu den am häufigsten Operationen in Deutschland. In diesem Artikel wird die Zahl der Schilddrüsenoperationen in Deutschland verglichen mit der Zahl in einigen anderen westlichen Ländern (Niederlande, USA, England). In Gegensatz zu der USA und England nimmt die Zahl der jährlich in Deutschland durchgeführten Schilddrüsenoperation ab, jedoch ist sie mit 109/100 000/Jahr im internationalen Vergleich deutlich erhöht (Niederlande: 16/100 000/Jahr, USA: mindestens 42/100 000/Jahr, England: mindestens 27/100 000/Jahr)

Zu den Faktoren, die an dieser erhöhten Zahl beitragen, zählen Iodmangel, der häufige Einsatz hochkomplexer Diagnostik (z. B. Ultraschall), die nicht ausreichende Benutzung präoperativer Diagnostik (Z.B. Feinnadelbiopsie) und das Betreiben “defensiver” Medizin. Es kann nicht abgeschätzt werden, in welchem Ausmaß jeder dieser Faktoren an der höheren Operationszahl beiträgt.

Keywords

Thyroid surgery - thyroid disease - indications for surgery - international comparison

Schlüsselwörter

Schilddrüsenoperation - Schilddrüsenerkrankung - OP-Indikation - internationaler Vergleich

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