title: Ethnic and economic disparities effect on management of hyperparathyroidism.
abstract: BACKGROUND
  Successful parathyroidectomy requires advanced surgeon experience. We aim to examine population characteristics at risk of being managed by low-volume surgeons.
  
  
  METHODS
  A cross-sectional study was performed utilizing the Nationwide Inpatient Sample database, 2004 to 2009. The study population included adult inpatients who underwent parathyroidectomy for primary hyperparathyroidism.
  
  
  RESULTS
  A total of 3,503 discharge records were included. Men, Hispanics, and those with Medicaid/Medicare health coverage were more likely to be managed by low-volume surgeons (P < .05 each). Low-volume surgeons were more likely to operate in rural (odds ratio [OR], 3.99; 95% confidence interval [CI], 1.95 to 8.16; P < .001) or nonteaching hospitals (OR, 2.15; 95% CI, 1.42 to 3.27; P < .001). Southern region of the United States had a high prevalence of low-volume surgeons compared with other regions (Southern: 51.3%, Northeast: 24.3%, Midwest: 25.6%, and West: 27.6%, P < .001). Operations by the low-volume surgeons associated with a higher risk of postoperative complications (OR, 1.81; 95% CI, 1.11 to 2.97) and a hospital stay more than 2 days (OR, 7.12; 95% CI, 3.75 to 13.45; P < .001).
  
  
  CONCLUSIONS
  Certain populations are at risk of management by low-volume surgeons based on their demographic and economic characteristics.
authors: Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors: Zaid
authors: Z
authors: Al-Qurayshi
authors: Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
authors: Adam
authors: A
authors: Hauch
authors: Department of Biostatistics and Bioinformatics, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
authors: Sudesh
authors: S
authors: Srivastav
authors: Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA. Electronic address: ekandil@tulane.edu.
authors: Emad
authors: E
authors: Kandil
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000191:economics / Q000208:ethnology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D012959:Socioeconomic Factors; D014481:United States; D044465:White People
keywords: Demographic factors; Health services cost; Parathyroid disorders; Parathyroidectomy; Primary hyperparathyroidism; Surgeon volume