Is there an association between surgeon volume and patients’ community health status with the outcomes of thyroid and parathyroid surgery for primary malignancies?
Background: Thyroid cancer is recognized as one of the most common malignancies in the United States, while malignant tumors of the parathyroid glands are comparatively rare. Thyroid cancer is recognized as one of the most common malignancies in the United States, while malignant tumors of the parathyroid glands are comparatively rare. Authors examined relationships among greater surgeon experience, living environment (geographical, social, economic, and administrative healthcare attributes), and favorable outcomes for thyroidectomy and parathyroidectomy outcomes.
Study design: Cross-sectional study of 6,347 patient records.
Setting: State Inpatient Databases, 2010–2011, for Florida, New York, and Washington, merged with the County Health Rankings database.
Synopsis: Thyroid cancer was seen in 99.7% of the study population; parathyroid cancer accounted for 0.3%. Most patients had one or no comorbidities at admission. Complications occurred in 12.6% of patients; 5.1% required ICU admission, 2.9% were readmitted in the following 30 days, and 0.1% died during their hospital stay. Patients managed by low-volume and intermediate-volume surgeons had a higher risk of post-operative complications and were significantly more likely to require ICU admission, readmission, and a hospital stay of more than two days. Low-volume surgeon costs were greater than $10,254.66 significantly more often than intermediate-volume surgeon costs. Self-paying patients, as well as those on Medicare or Medicaid, more often saw low-volume surgeons than did those with private insurance. Patients who lived in high health risk communities were more likely to experience post-operative complications and ICU admittance than those living in low health risk communities. Black and Hispanic patients were more likely to receive treatment by low-volume surgeons. Limitations revolved around the administrative nature of the database, which lacks good representation of case severity and clinical details such as histopathological or management specifics.
Bottom line: The surgeon’s volume and the patient’s living conditions are crucial and independent factors in endocrine cancer management and can have significant impact on the outcomes.
Citation: Al-Qurayshi Z, Randolph GW, Srivastav S, Kandil E. Outcomes in endocrine cancer surgery are affected by racial, economic, and healthcare system demographics. Laryngoscope. 2016;126:775-781.