Racial disparities in clinical and economic outcomes from thyroidectomy.
BACKGROUND
Thyroid disease is common, and thyroidectomy is a mainstay of treatment for many benign and malignant thyroid conditions. Overall, thyroidectomy is associated with favorable outcomes, particularly if experienced surgeons perform it.


OBJECTIVE
To examine racial differences in clinical and economic outcomes of patients undergoing thyroidectomy in the United States.


METHODS
The nationwide inpatient sample was used to identify thyroidectomy admissions from 1999 to 2004, using ICD-9 procedure codes. Race and other clinical and demographic characteristics of patients were collected along with surgeon volume and hospital characteristics to predict outcomes.


METHODS
Inpatient mortality, complication rates, length of stay (LOS), discharge status, and mean total costs by racial group.


RESULTS
In 2003-2004, 16,878 patients underwent thyroid procedures; 71% were white, 14% black, 9% Hispanic, and 6% other. Mean LOS was longer for blacks (2.5 days) than for whites (1.8 days, P < 0.001); Hispanics had an intermediate LOS (2.2 days). Although rare, in-hospital mortality was higher for blacks (0.4%) compared with that for other races (0.1%, P < 0.001). Blacks trended toward higher overall complication rates (4.9%) compared with whites (3.8%) and Hispanics (3.6%, P = 0.056). Mean total costs were significantly lower for whites ($5447/patient) compared with those for blacks ($6587) and Hispanics ($6294). The majority of Hispanics (55%) and blacks (52%) had surgery by the lowest-volume surgeons (1-9 cases per year), compared with only 44% of whites. Highest-volume surgeons (>100 cases per year) performed 5% of thyroidectomies, but 90% of their patients were white (P < 0.001). Racial disparities in outcomes persist after adjustment for surgeon volume group.


CONCLUSIONS
These findings suggest that, although thyroidectomy is considered safe, significant racial disparities exist in clinical and economic outcomes. In part, inequalities result from racial differences in access to experienced surgeons; more data are needed with regard to racial differences in thyroid biology and surveillance to explain the balance of observed disparities.
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520, USA. julie.sosa@yale.edu
Julie Ann
JA
Sosa
Pritesh J
PJ
Mehta
Tracy S
TS
Wang
Heather L
HL
Yeo
Sanziana A
SA
Roman
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000208:ethnology* / Q000601:surgery; D013965:Thyroidectomy / Q000191:economics*; D014481:United States / Q000453:epidemiology