Utilization of total thyroidectomy for papillary thyroid cancer in the United States.
BACKGROUND
Despite guidelines that recommend total thyroidectomy for papillary thyroid cancer (PTC) greater than or equal to 1 cm, the extent of surgery remains controversial. We examined surgical practice patterns for PTC greater than or equal to 1 cm and identified factors that predict the use of total thyroidectomy.


METHODS
Of 90,382 patients in the National Cancer Center Data Base (NCDB) with PTC from 1985 to 2003, 57,243 patients had tumors greater than or equal to 1 cm and underwent total thyroidectomy or lobectomy. Trends in extent of surgery for PTC were examined over 2 decades. Logistic regression was used to identify factors that predict use of total thyroidectomy compared with lobectomy.


RESULTS
Use of total thyroidectomy increased from 70.8% in 1985 to 90.4% in 2003 (P < .0001). Patients were less likely to undergo total thyroidectomy if they were black, older than 45 years, had Medicare, had lower household incomes, or had less education (P < .0001). Moreover, patients treated at high-volume or academic centers were more likely to undergo total thyroidectomy than were patients examined at low-volume or community hospitals (P < .0001).


CONCLUSIONS
Use of total thyroidectomy for PTC greater than or equal to 1 cm increased over time. Differences in use of total thyroidectomy are related to patient, tumor, and hospital factors and likely reflect disparities in access to care.
Bilimoria
Karl Y
KY
Department of Surgery, Division of Surgical Oncology, Northwestern University, Chicago, Ill., USA.
Bentrem
David J
DJ
Linn
John G
JG
Freel
Andrew
A
Yeh
Jen Jen
JJ
Stewart
Andrew K
AK
Winchester
David P
DP
Ko
Clifford Y
CY
Talamonti
Mark S
MS
Sturgeon
Cord
C
D000368:Aged; D002291:Carcinoma, Papillary / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012042:Registries; D013964:Thyroid Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology