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Racial Disparities in Clinical and Economic Outcomes From Thyroidectomy
Abstract
CONTEXT: 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. DESIGN, SETTING, PATIENTS: 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. MAIN OUTCOME MEASURES: 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.
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“Robust data demonstrate that surgeon volume of thyroidectomies is an independent predictor of patient clinical and economic outcomes (i.e., in-hospital complications, length of stay, and total hospital charges) following thyroid surgery (198,199,293).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [293]
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Metadata
- Authors
- Sosa, J. A., Mehta, P. J., Wang, T. S., Yeo, H. L., & Roman, S. A.
- Affiliations
- Yale University (US)
- Venue
- Annals of Surgery
- Published
- 2007-12
- Volume
- 246
- Issue
- 6
- Pages
- 1083-1091
- ISSN
- 0003-4932 (ISSN-L)
- OpenAlex
- W2040133484
- Cited by
- 188
- References
- 29
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 13 · 2023: 19 · 2022: 21 · 2021: 31 · 2020: 16 · 2019: 11 · 2018: 7 · 2017: 4 · 2016: 9 · 2015: 8 · 2014: 5 · 2013: 8 · 2012: 6
- FWCI
- 4.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Keywords
- thyroidectomy, racial disparities, health care disparities, in-hospital mortality, postoperative complications, length of hospital stay, hospital costs, surgeon volume, Black patients, Hispanic patients, Caucasian patients
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Ethnicity, Female, Humans, Inpatients, Length of Stay, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Thyroid Diseases, Thyroidectomy, United States, Hospital Mortality, Hospital Costs
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