title: Demographics, disparities, and outcomes in substernal goiters in the United States.
abstract: BACKGROUND
  Disparities distinguishing patients with substernal goiters from nonsubsternal goiters have not been thoroughly described.
  
  
  METHODS
  The National Inpatient Sample database was used to compare patients who underwent substernal thyroidectomy years 2000 to 2010 with those who underwent thyroidectomy for nonsubsternal goiter.
  
  
  RESULTS
  A total of 110,889 patients underwent thyroidectomy for goiter (5,525 substernal and 105,364 nonsubsternal). Substernal thyroidectomy patients were older, more likely to be Black or Hispanic and to have Medicare insurance. They had a higher comorbidity index, were more likely to be admitted emergently and to have postoperative complications such as hemorrhage/hematoma, pneumothorax, pulmonary embolism, and hypocalcemia/hypoparathyroidism. Furthermore, substernal thyroidectomy patients had 73% increased odds of death during admission than nonsubsternal thyroidectomy patients.
  
  
  CONCLUSIONS
  Substernal goiters present a distinct type of goiter with identifiable patient-level characteristics and an increased risk of postoperative complications and death. Earlier identification and treatment of goiters may allow earlier interventions at a stage when risks are reduced.
authors.affiliation: Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Ambria S
authors.initials: AS
authors.lastname: Moten
authors.affiliation: University of Pennsylvania Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA, USA.
authors.forename: Dylan P
authors.initials: DP
authors.lastname: Thibault
authors.affiliation: University of Pennsylvania Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA, USA.
authors.forename: Allison W
authors.initials: AW
authors.lastname: Willis
authors.affiliation: Thyroid and Parathyroid Surgery Program, Department of Surgery, Thomas Jefferson University, 1100 Walnut St., Suite 500, Philadelphia, PA, USA. Electronic address: alliric.willis@jefferson.edu.
authors.forename: Alliric I
authors.initials: AI
authors.lastname: Willis
mesh_terms: D000367:Age Factors; D015897:Comorbidity; D003710:Demography; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006042:Goiter / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D012307:Risk Factors; D013249:Sternum; D013965:Thyroidectomy; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Disparity; Substernal goiter; Thyroidectomy