Outcomes in thyroid surgery are affected by racial, economic, and heathcare system demographics

Objectives/Hypothesis

Disparities in economic and social parameters have been identified as underlying factors that influence diseases outcomes. We aim to examine the influence of community-specific measures on outcomes related to thyroid surgery.

Study Design

A cross-sectional study utilizing the State Inpatient databases and State Ambulatory Surgery and Services databases, 2010 to 2011. Those databases were merged with the County Health Ranking database.

Methods

The study population included adult (≥18 years) inpatients and outpatients who underwent thyroidectomy. Access and outcomes of thyroidectomy was assessed in relation to demographics and health-risk status of the patient's community.

Results

A total of 14,220 inpatient and 7,215 outpatient thyroidectomies were included. Low-volume surgeons were more likely to operate on patients living in high-risk communities (P < .05). Patients from these communities of high health risk were more likely to be women, and African Americans (P < .05 each). Compared to low-risk communities, patients from high-risk settings had a higher risk of postoperative complications (odds ratio: 1.58, 95% confidence interval: 1.23, 2.04, P < .001). They also experienced longer hospitalization (P = .003) and higher readmission risk (3.0% vs. 1.5%, P = .03). Interestingly, despite divergent and lower outcome parameters, hospital charges for patients of high-risk communities were in the highest quartile (>$34,535.55) compared to low-health-risk communities (P < .001).

Conclusions

Patients from high-health-risk communities and who are undergoing thyroidectomies are more likely to be women and African Americans. Management of those patients is more likely to be performed by low-volume surgeons and more likely to be associated with unfavorable outcomes.

Level of Evidence

4. Laryngoscope, 2016

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