Adam Hauch1, Zaid Al-Qurayshi1, Paul Friedlander2, Emad Kandil2. 1. Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana. 2. Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana2Department of Otolaryngology, Tulane University School of Medicine, New Orleans, Louisiana.
Abstract
IMPORTANCE: For the management of thyroid diseases, there have been few studies aimed at examining the association between disparities and outcomes. OBJECTIVE: To measure the effects of race, ethnicity, and socioeconomic status on outcomes following thyroid surgery. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis of 62,722 thyroid procedures identified in the Nationwide Inpatient Sample (NIS) from 2003 through 2009. INTERVENTIONS: Thyroidectomy. MAIN OUTCOMES AND MEASURES: The first set of outcomes included postoperative complication, length of stay (LOS), and overall cost in relation to selected hospital and surgeon characteristics. The second set encompassed accessibility to different surgeon and hospital volumes, hospital locations, and hospital teaching status based on race/ethnicity, income, and health service payer. RESULTS: The majority of cases were total thyroidectomies (57.9%) for benign conditions (60.8%). Low-volume surgeons performed most operations (90.8%). Low surgeon volume was associated with higher risk of postoperative complications compared with higher surgeon volume (17.2% vs 12.1%; P < .001). Low-volume compared with high-volume hospitals had higher rates of postoperative complications (17.7% vs 15.1%; P < .001). High surgeon volume was associated with a decreased LOS (mean [SD], 1.74 [0.02] vs 1.20 [0.07] days; P < .001). In addition, LOS was longer at low-volume hospitals (1.85 [0.02] vs 1.57 [0.03] days; P = .001). Hispanics were more likely to be operated on by low-volume surgeons (odds ratio [OR], 2.04; 95% CI, 1.19-3.48), and in certain regions throughout the United States, blacks were more likely to be operated on by low-volume surgeons. Patients with Medicare (OR, 1.30; 95% CI, 1.13-1.53) and lower income (OR, 1.73; 95% CI, 1.19-2.53) were more likely to be treated at low-volume centers. Minorities, including Hispanics, blacks, and other race/ethnicity, were more likely to have their operation in an urban setting (P < .005 for all). Blacks were less likely to have operations performed at nonteaching institutions (OR, 0.48; 95% CI, 0.38-0.60), as were people without private insurance (P < .05 for Medicare, Medicaid, and self-pay). CONCLUSIONS AND RELEVANCE: There are significant socioeconomic and racial disparities in thyroid surgery outcomes. Low-volume centers and surgeons had a significantly longer LOS and higher risk of complications, and inequalities were prevalent concerning access to these high-volume hospitals and surgeons.
IMPORTANCE: For the management of thyroid diseases, there have been few studies aimed at examining the association between disparities and outcomes. OBJECTIVE: To measure the effects of race, ethnicity, and socioeconomic status on outcomes following thyroid surgery. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis of 62,722 thyroid procedures identified in the Nationwide Inpatient Sample (NIS) from 2003 through 2009. INTERVENTIONS: Thyroidectomy. MAIN OUTCOMES AND MEASURES: The first set of outcomes included postoperative complication, length of stay (LOS), and overall cost in relation to selected hospital and surgeon characteristics. The second set encompassed accessibility to different surgeon and hospital volumes, hospital locations, and hospital teaching status based on race/ethnicity, income, and health service payer. RESULTS: The majority of cases were total thyroidectomies (57.9%) for benign conditions (60.8%). Low-volume surgeons performed most operations (90.8%). Low surgeon volume was associated with higher risk of postoperative complications compared with higher surgeon volume (17.2% vs 12.1%; P < .001). Low-volume compared with high-volume hospitals had higher rates of postoperative complications (17.7% vs 15.1%; P < .001). High surgeon volume was associated with a decreased LOS (mean [SD], 1.74 [0.02] vs 1.20 [0.07] days; P < .001). In addition, LOS was longer at low-volume hospitals (1.85 [0.02] vs 1.57 [0.03] days; P = .001). Hispanics were more likely to be operated on by low-volume surgeons (odds ratio [OR], 2.04; 95% CI, 1.19-3.48), and in certain regions throughout the United States, blacks were more likely to be operated on by low-volume surgeons. Patients with Medicare (OR, 1.30; 95% CI, 1.13-1.53) and lower income (OR, 1.73; 95% CI, 1.19-2.53) were more likely to be treated at low-volume centers. Minorities, including Hispanics, blacks, and other race/ethnicity, were more likely to have their operation in an urban setting (P < .005 for all). Blacks were less likely to have operations performed at nonteaching institutions (OR, 0.48; 95% CI, 0.38-0.60), as were people without private insurance (P < .05 for Medicare, Medicaid, and self-pay). CONCLUSIONS AND RELEVANCE: There are significant socioeconomic and racial disparities in thyroid surgery outcomes. Low-volume centers and surgeons had a significantly longer LOS and higher risk of complications, and inequalities were prevalent concerning access to these high-volume hospitals and surgeons.
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