title: Outcomes in endocrine cancer surgery are affected by racial, economic, and healthcare system demographics.
abstract: OBJECTIVE
  Surgeon experience has been recognized in several clinical fields as a significant element of superior management outcomes. In this study, we seek to assess the association between surgeon volume and patients' community health status with the outcomes of thyroid and parathyroid surgery indicated for primary malignancies.
  
  
  METHODS
  A cross-sectional study utilizing the State Inpatient Databases, 2010-2011, for Florida, New York, and Washington was merged with the County Health Rankings database.
  
  
  METHODS
  International Classification of Diseases, Ninth Revision codes were used to identify adult (≥18 years) patients who underwent thyroidectomy or parathyroidectomy indicated for primary malignancies.
  
  
  RESULTS
  A total of 6,347 records were included. Compared to high-volume surgeons, patients treated by low-volume surgeons were more likely to develop postoperative complications in the 1-month period after the operation (odds ratio: 4.34, 95% confidence interval: 3.31-5.70, P < .001). Furthermore, both low- and intermediate-volume surgeons were associated with a longer hospital stay (>2 days) and a higher risk of admission to the intensive care unit (P < .01 each). Cost of health services was significantly in the highest quartile (>$10,254.66) for patients treated by low-volume surgeons (P < .001). Patients who lived in communities of poor health measures had a higher risk of postoperative complications (16.3% vs. 11.8%, P = .030) independent of the clinical presentation and management type. Patients living in high health-risk communities and those of black and Hispanic backgrounds were more likely to be treated by low-volume surgeons (P < .001 each).
  
  
  CONCLUSIONS
  The surgeon's volume and the patient's living conditions are crucial and independent factors in multiple aspects of endocrine cancer management.
  
  
  METHODS
  4 Laryngoscope, 126:775-781, 2016.
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Al-Qurayshi
authors.affiliation: Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Randolph
authors.affiliation: Department of Biostatistics and Bioinformatics, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, U.S.A.
authors.forename: Sudesh
authors.initials: S
authors.lastname: Srivastav
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
authors.forename: Emad
authors.initials: E
authors.lastname: Kandil
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D003710:Demography; D004701:Endocrine Gland Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005431:Florida; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D061846:Hospitals, Low-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010282:Parathyroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D063505:Racism; D018570:Risk Assessment; D012959:Socioeconomic Factors; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods* / Q000401:mortality
keywords: Thyroid cancer; demographic; endocrine cancer; parathyroid cancer; parathyroidectomy; patient community; patient environment; surgeon volume; thyroidectomy