Outcomes in thyroid surgery are affected by racial, economic, and healthcare system demographics

Al‐Qurayshi, Zaid; Randolph, Gregory W.; Srivastav, Sudesh; Aslam, Rizwan; Friedlander, Paul; Kandil, Emad

doi:10.1002/lary.25871

Cited by 24 publications

(12 citation statements)

References 23 publications

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“…Another study by Sosa et al (5) revealed that the majority of Blacks had surgery by the lowest-volume surgeons, as compared with a smaller proportion of Whites. In another study, Al-Qurayshi et al analyzed more than 20,000 thyroidectomies and found that African American patients from high-risk communities (risk was based on smoking, obesity, excessive alcohol consumption, educational level, unemployment, and income among other factors) were more commonly operated on by low-volume surgeons, with postoperative complications being more common in this population (15). However, even when surgeon volume was adjusted for, Sosa et al found that significant racial disparities in length of stay and cost persisted (5).…”

Section: Disease Care Issn: 2329-9711 | November 2020 | Volume 32 | Imentioning

confidence: 99%

Racial Disparities in Thyroid Disease Care

Gavigan

Cooper

2020

Clinical Thyroidology

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Background Recent protests over police brutality as well as the COVID-19 pandemic have brought to light the systemic racism that pervades all sectors of our society, including the practice of medicine (1,2). Not unexpectedly, racial inequity is found in many areas of endocrinology (3), most notably in diabetes. A PubMed search, completed on October 2, 2020, of "racial disparities in diabetes" found over 1000 papers on this subject published since 2015.

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Section: Disease Care Issn: 2329-9711 | November 2020 | Volume 32 | Imentioning

confidence: 99%

Racial Disparities in Thyroid Disease Care

Gavigan

Cooper

2020

Clinical Thyroidology

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“… 37 Women and African Americans are affected disproportionately, and, unfortunately, this results in higher complication rates. 43 NSQIP (National Surgical Quality Improvement Program) data have shown that most of the patients offered outpatient thyroidectomy have private insurance. The decision to offer outpatient thyroidectomy to a patient may be due to the patient’s higher socioeconomic stratum and closer proximity to tertiary centers in urban areas.…”

Section: Factors Relating To Patient Selectionmentioning

confidence: 99%

Is Outpatient Thyroid Surgery for Everyone?

Butler

Oltmann

2017

Clin Med Insights Ear Nose Throat

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Thyroidectomy is a common surgical procedure. Traditionally, surgeons have performed thyroidectomy on an inpatient basis. However, consistent with current trends in surgery, some practices are transitioning thyroidectomy to an outpatient setting. Although concerns for hypocalcemia and postoperative bleeding exist regardless of surgeon experience, multiple studies demonstrate that outpatient thyroidectomy is safe in the hands of high-volume surgeons. Indeed, experienced thyroid surgeons who perform thyroidectomy in an outpatient setting experience excellent patient outcomes and reduced costs. However, outpatient thyroidectomy may not be suitable for all surgeons, hospitals, or patients. When evaluating whether to implement an outpatient thyroid program, a practice should consider a number of important factors including the team performing the procedure, the hospital, and the patient. With the appropriate staff education and experience, hospital setting, and patient selection, practices in a multitude of settings can successfully develop a safe, cost-effective outpatient thyroid program.

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“…15 Additional studies have shown decreases in operative times, decreased length of stay, and an increase in outpatient surgery with higher volume surgeons. [16][17][18][19] This could be one of the reasons why low-volume centers and community cancer centers favor unilateral lobectomy. Further studies are needed to explore this discrepancy.…”

Section: Thyroid Lobectomy Versus Total Thyroidectomymentioning

confidence: 99%

“…This differential could potentially lead to disparities in care as patients who are in lower socioeconomic groups and minorities have been shown previously to get care more often with lower volume surgeons. 27 This care was also more likely to be associated with poorer outcomes as lower volume surgeons have been shown to have poorer outcomes for thyroid surgery. 8…”

Section: Central Neck Dissectionmentioning

confidence: 99%

Disparities in the Care of Differentiated Thyroid Cancer in the United States: Exploring the National Cancer Database

Jaap

Campbell

Dove

et al. 2017

The American Surgeon™

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Differentiated thyroid cancer (DTC) treatment is multifaceted, and may be influenced by socio-economic factors. The goal of this study is to examine disparities in DTC treatment. DTC patients from 1998 to 2012 were identified using the National Cancer Database. DTC was identified in 262,041 patients. The mean age was 48.2. The majority of patients (52%) received care at Comprehensive Community Cancer Programs (CCCPs). Total thyroidectomy was less common at Community Cancer Programs (CCPs) [odds ratio (OR): 0.735; 95% confidence interval (CI): 0.707–0.764), and more common at academic centers (OR: 1.129; 95% CI: 1.102–1.157) compared with CCCP. A central neck dissection was performed most often at academic center (20.6%) versus CCP (10.0%). Black patients were less likely to undergo central neck dissection compared with white patients (OR: 0.468; 95% CI: 0.452–0.484). Patients more likely to receive radioactive iodine were white compared with black patients (hazard ratio: 0.833; 95% CI: 0.806–0.861), privately insured compared with uninsured patients (hazard ratio: 1.272; 95% CI: 1.210–1.341), and patients treated at CCCP. Disparities exist in DTC treatment. Individuals at risk for under-treatment are black patients, uninsured patients, and those treated at CCP. As the Affordable Care Act changes access to health care, future studies will be needed to readdress disparities.

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Outcomes in thyroid surgery are affected by racial, economic, and healthcare system demographics

Abstract: 4. Laryngoscope, 126:2194-2199, 2016.

Cited by 24 publications

References 23 publications

Racial Disparities in Thyroid Disease Care

Racial Disparities in Thyroid Disease Care

Is Outpatient Thyroid Surgery for Everyone?

Disparities in the Care of Differentiated Thyroid Cancer in the United States: Exploring the National Cancer Database

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