title: The impact of surgical volume on racial disparity in thyroid and parathyroid surgery.
abstract: OBJECTIVE
  The aim of this study was to evaluate the association between surgeon volume and patient outcomes among different race ethnicities undergoing thyroid or parathyroid surgery.
  
  
  METHODS
  The nationwide inpatient sample was used to identify all thyroidectomy and parathyroidectomy admissions from 2003 to 2009, using International Classification of Diseases, 9th Clinical Modification (ICD-9-CM) procedure codes. Race, demographic, and clinical characteristics of patients were collected, along with surgeon volume, to predict the length of stay (LOS), complication rates, mortality, and total charges by racial group, using univariate and multivariate analyses.
  
  
  RESULTS
  A total of 106,314 thyroid and parathyroid surgeries were included in the current analysis. Of these patients, 54 % were Caucasian, 11 % African American, 7 % Hispanic, and 3 % Asian. Mean LOS was longer for African American patients (4 ± 8.7 days) than for Caucasians (2.3 ± 5.5 days) [p < 0.001]. African Americans had higher overall complications (16.8 %) compared with Caucasians (11 %), Hispanics (13.5 %), and Asians (12 %) [p < 0.001]. In-hospital mortality was higher for African Americans (0.8 %) compared with that from other race groups (0.3 %) [p < 0.001]. Mean total charges were significantly higher for African Americans ($33,292 ± $67,387) compared with those for Caucasians ($22,855 ± $40,167) (p < 0.001). African Americans had less access to intermediate- (10-99 cases) and high- (>100 cases) volume surgeons compared with Caucasians-45 versus 49 %, and 16 versus 19 %, respectively (p < 0.001). Higher surgeon volume was associated with improved outcomes (p < 0.001). Racial disparity in all investigated outcomes was still significantly evident even after stratification by surgeon volume.
  
  
  CONCLUSIONS
  Higher surgeon volume is associated with improved patient outcomes. However, our data suggests that the observed racial disparities in thyroid and parathyroid surgery go beyond access to quality healthcare providers.
authors.affiliation: Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA, snouredi@tulane.edu.
authors.forename: Salem I
authors.initials: SI
authors.lastname: Noureldine
authors.forename: Ali
authors.initials: A
authors.lastname: Abbas
authors.forename: Ralph P
authors.initials: RP
authors.lastname: Tufano
authors.forename: Sudesh
authors.initials: S
authors.lastname: Srivastav
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Slakey
authors.forename: Paul
authors.initials: P
authors.lastname: Friedlander
authors.forename: Emad
authors.initials: E
authors.lastname: Kandil
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000601:surgery; D016105:Parathyroidectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D011787:Quality of Health Care; D012189:Retrospective Studies; D013043:Specialties, Surgical / Q000592:standards*; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects*